Urethritis is inflammation of urethra (the passage through which urine is passed from urinary bladder to the outside). Urethritis is fairly common STI (sexually transmitted infection) among sexually active males (more so among adolescence age group).
What are the symptoms of urethritis?
The common symptoms of urethritis are discharge from urethra and pain during micturition or urination. Commonly both of these symptoms are seen in case of urethritis. Generally there is no change in frequency of urination.
What are the causative agents of urethritis?
The commonest cause of urethritis in men is Neisseria gonorrhoeae (the causative agent for gonorrhea). Other common organisms which can cause urethritis are Clamidia. trachomatis, Mycoplasma genitalium, Ureaplasma urealyticum, Trichomonas vaginalis, HSV (herpes simplex virus), coliform (commonly seen in men practicing insertive anal intercourse) etc. Among nongonococcal urethritis (NGU), approximately one third of the cases are due to Clamidia. Trachomatis (older men with urethritis generally are less likely be due to chlamydial infection), although the cases are declining these days.
In many populations, the urethritis in men due to Clamidia. trachomatis, has declined to an extent due to effective chlamydial-control programs. HSV and T. vaginalis cause a small proportion nongonococcal urethritis (NGU) in men. Other causes of NGU are M. genitalium, Ureaplasma urealyticum, Ureaplasma parvum, coliform etc.
If a case of urethritis is suspected it should be properly investigated and treated appropriately without delay. At first, only Neisseria gonorrhoeae and Clamidia. trachomatis, should be tested with specific tests.
The CDC (Centers for Disease Control and Prevention) is compiling reports of STIs (Sexually Transmitted Infections) since 1941. For example one of the common STDs (Sexually Transmitted Diseases) gonorrhea was lower than other years at approximately 112 cases per 100,000 populations in 2004 in the US, which was highest in the mid 70s to more than 450 cases per 100,000 per year.
The incidence of syphilis (both primary and secondary) was more than 70 per 100,000 populations in the US in 1946 and fell rapidly to below 4 per 100,000 populations in 1956, due to increased use of effective antibiotics (which reduced the duration of infectivity). After 1956 there was slight increase in the incidence of syphilis till 1987 (approximately 10-15 cases per 100,000 populations per year, due to with marked increase among homosexual men and African Americans) and started reducing again (most marked decrease among heterosexual African Americans), which is approximately 2 cases per 100,000 populations per year at present.
But unfortunately there is increase in number of STIs like gonorrhea, syphilis, chlamydial infection etc. since 1996 in US as well as many other Western nations, due to introduction of highly active antiretroviral (anti HIV) therapy as well as due to the avoidance by some homosexual men of unprotected sex with HIV partners but not with HIV negative partners (a strategy that provides no protection against STIs other than HIV infection). There is also increased number of a rare type of chlamydial infection (lymphogranuloma venereum or LGV) that had virtually disappeared.
In general due to fear of HIV transmission (which prompted behavioral change) since the mid-1980s along with better-organized systems of care for the curable STIs the number of STIs have come down drastically in most of the industrialized nations including US. But due to availability of potent antiretroviral therapy the risk taking seems to be increasing, as is evident by the increased number of STIs in recent years.
Worldwide it is estimated that most adults acquire at least one STI in their lifetime. Throughout the world sexually transmitted diseases (STDs) or STIs (sexually transmitted infections) rank among the most common infections.Certain STIs are distributed evenly throughout any society, e.g. are chlamydial infections, genital infections with HPV, genital herpes etc.
Some STIs are distributed among “core populations”. The ‘core populations’ include high rates of sexual partner change, some homosexual men, multiple concurrent sexual partners, highly connected sexual networks (involving prostitutes and their clients), users of illicit drugs (drug abusers especially crack cocaine, methamphetamine etc.). Examples of these “core populations” STIs are syphilis, gonorrhea, HIV infection, hepatitis B, chancroid etc.
At present more than 30 infections are there which can be classified under STDs (sexually transmitted diseases, sexually transmissible diseases with sexual mode as minor mode and sexually transmissible diseases). 90% of the worlds STIs (sexually transmitted infections) are seen in the developing countries where 75% of the world population resides. There are many factors for high numbers of STIs in the developing countries, like rural to urban migration, high population growth (especially high number of young adults), poverty, wars etc. which causes risky sexual behavior.
Generally three factors influence the rate of spread of STDs in a community. These factors are rate of sexual exposure of susceptible individuals to infectious (STDs) people, duration of infectivity (longer duration if not treated adequately) and efficiency of transmission of STDs per sexual exposure. So aim and efforts of preventing (and reducing) STDs should be to decrease the rate of sexual exposure of susceptible individuals to infected persons (by individual counseling), reduce duration of infectivity by early diagnosis and prompt curative or suppressive treatment and to reduce efficiency of transmission by use of barrier methods like condoms and safer sexual practices and recently through male circumcision (in selected cases).
STDs or sexually transmitted diseases are pretty common throughout the world and it is estimated that most of the adults acquire at least one sexually transmitted disease in their life time. For example in United States alone more than 6 million people acquire new genital human papillomavirus (HPV) infection and worst is, most of these people who acquire genital human papillomavirus infection are at risk of developing genital neoplasm. From this one example it is not difficult to estimate how common STD is. In all societies of the world sexually transmitted diseases are among the most common infectious diseases.
There are more than 30 infections which are classified as predominantly sexually transmitted or as sexually transmissible (frequently). These are named below:
Transmitted predominantly by sexual intercourse in adults (name of the organism given in brackets):
Gonorrhea (Neisseria gonorrhoeae), syphilis (Treponema pallidum), lower genital tract infections in females and epididymitis in males (Chlamydia trachomatis), genital ulcers (Haemophilus ducreyi), urethritis in males (Ureaplasma urealyticum), genital ulcers (Calymmatobacterium granulomatis).
AIDS (HIV or human immune deficiency virus types 1 and 2), genital herpes (Herpes simplex virus type 2), Hepatitis B (Hepatitis B virus), genital and anal warts (Human papillomavirus), Molluscum contagiosum (Molluscum contagiosum virus), T cell leukemia (Human T-cell lymphotropic virus type I).
Trichomonas vaginalis infection and pediculosis of pubic area (Phthirus pubis).
Sexual Transmission Repeatedly Described but Not the Predominant Mode (name of the organism given in brackets):
Urethritis in males (Mycoplasma genitalium), bacterial vaginosis (Gardnerella vaginalis), (Mycoplasma hominis), (Group B Streptococcus), (Helicobacter cinaedi), (Helicobacter fennelliae).
CMV or cytomegalovirus mononucleosis (Cytomegalovirus), lymphoma (Human T-cell lymphotropic virus type II), hepatitis (Hepatitis C, D viruses), genital herpes (Herpes simplex virus type 1), infectious mononucleosis (Epstein-Barr virus).
Candidiasis (Candida albicans) and scabies (Sarcoptes scabiei).
Transmissible by sexual contacts (Oral-Fecal Exposure) mainly in Homosexual Men:
Shigellosis (Shigella species) and Proctocolitis or enterocolitis (Campylobacter species).
Hepatitis (Hepatitis A).
Giardiasis (Giardia lamblia) and amebiasis (Entamoeba histolytica).