Traumatic urethritis in women: signs, complications, diagnosis, treatment and prevention. Urethritis Urethritis in girls

In urology, inflammation of the urethra is called urethritis. Tests for this disease are performed for several purposes:

• confirmation of diagnosis;
• differential diagnosis with other pathologies that give similar symptoms;
• determining the cause of urethritis, as it affects the choice of treatment tactics;
• in the case of infectious urethritis - identification of the causative agent of the disease;
• assessment of the sensitivity of microbes to antibiotics to select the most effective therapy.

Let's talk about what tests you need to take for urethritis.

• Urethral smear for urethritis
• Culture of a smear from the urethra
• How to prepare for tests

General urine test for urethritis

Diagnosis in women and men often begins with general clinical examinations. Among other things, a general urine test is performed. It shows signs of inflammation. These are leukocytes - white blood cells responsible for immune reactions. But this study is only indicative. It indicates that there is inflammation in the genitourinary system. But it does not tell the doctor exactly where the pathology is located. Because urine passes through many organs along the way. It is not known where exactly she “picked up” these leukocytes. After all, these cells could get into the urine not only from the urethra. These could be the kidneys, ureters, prostate, bladder. Therefore, further diagnostics are required to determine the localization of the pathology.

Two-glass urine sample for urethritis

If leukocytes are detected in urine tests for urethritis, a two-glass test will help to distinguish this disease from pyelonephritis or cystitis. Its essence is that the patient urinates alternately into two vessels.

If pus is detected in the first one, most likely the pathology is localized in the urethra or prostate. Because the first portion flushes pus from the urethra. It may be there if:

• pus formed directly in the urethra;
• pus entered the urethra from the prostate gland and accumulated in it.

But if the first portion is clear, and the second is cloudy (with leukocytes), this indicates that the kidneys or bladder are inflamed. A three-glass sample provides more accurate information. The patient releases the first stream of urine into the first vessel, then the main part of the urine into the second, and the rest into the third.

With urethritis, there will be pus only in the first glass. For cystitis - only in the third. For pyelonephritis - evenly in all portions.

Urine according to Nechiporenko for urethritis

Sometimes, if urethritis is suspected, a urine test according to Nechiporenko is prescribed. It involves counting the number of leukocytes and red blood cells in the morning urine.

Normally, leukocytes should not be more than 4x10 6 cells per liter. The norm of red blood cells is half that – 2x10 6 cells per liter.

In case of controversial results, it is possible to repeat the Nechiporenko analysis after a provocative test. Pyrogenal or prednisolone is administered. After this, the inflammatory process is activated and a large number of leukocytes are detected in the urine.

Urethral smear for urethritis

If urethritis is suspected, a smear is always given. It is studied under a microscope. This method of diagnosing urethritis is one of the most effective, despite its simplicity.

A smear is taken from the urethra. It is fixed on the glass and painted. Then the doctor examines the biomaterial. Various pathological changes can be detected in it. The most important of them is an increased level of leukocytes. Normally there should be no more than 5 of them in the field of view. There are other indicators. There should be no more than 10 epithelial cells in the smear.

The amount of mucus is moderate. The presence of single cocci is allowed. Because microorganisms live in the distal part of the male urethra. Only the proximal portion should be sterile. But the presence of a large number of bacteria often speaks in favor of nonspecific urethritis. Also, during microscopy, pathogens of sexually transmitted infections can be detected.

The doctor is able to see gonococci, trichomonas and candida. Most often, urethritis is infectious. Very rarely it is caused by allergic reactions, trauma, burns, radiation or allergies. But such cases also sometimes occur, and the doctor takes this into account during the diagnostic process.

Culture of a smear from the urethra

Culture for urethritis is one of the most informative studies. It allows you to establish the etiology of the disease.

Culture is used to determine nonspecific urethritis. This is a form of infectious inflammatory process that is caused by opportunistic bacteria or fungi.

The following can grow on a nutrient medium:

• gram-negative rods;
• enterobacteria;
• corynebacteria;
• hemophiliacs;
• streptococci;
• staphylococci;
• yeast.

The result of the study is given quantitatively. It is measured in colony-forming units.

The main indicators of analysis for urethritis are as follows:

• indication of the fact of colony growth on a nutrient medium;
• indication of the type of microorganism or several microorganisms;
• indication of their number in CFU.

If a microorganism is detected in quantities exceeding 10 4 CFU/tampon, its sensitivity to antibiotics is determined.

The doctor receives the antibiogram data. Various antibiotics are indicated in the column. The table indicates the level of susceptibility of the isolated bacteria to it. Pathogens may be sensitive, insensitive, or resistant to a particular drug.

For treatment, the antibiotic whose susceptibility is maximum is selected.

The doctor can also take a culture for:

• yeast-like fungi (candidiasis);
• chlamydia;
• ureaplasma;
• mycoplasmosis;
• gonorrhea;
• Trichomonas.

These are causative agents of sexually transmitted infections. They also grow on nutrient media. But to identify them, separate tests are needed.

Tests for sexually transmitted infections for urethritis

According to the etiological factor, all infectious urethritis are divided into three groups:

• gonococcal;
• non-gonococcal;
• nonspecific.

The first group occurs as a result of infection with gonorrhea. This is one of the common venereal diseases. It almost always leads to inflammation of the urethra. The pathology occurs especially rapidly in men. They usually secrete a large amount of pus.

Gonorrhea can often be suspected based on symptoms alone. But confirmation in any case requires laboratory diagnostics.

Gonococci can be detected even by smear microscopy. Especially in men, against the background of heavy discharge from the urethra. But they are not always revealed. Their absence in the smear does not mean that there are no gonococci. It just means more accurate diagnostic tests are needed. Therefore, in such cases, PCR is performed, and less often, tank culture is performed.

Postgonococcal urethritis is classified as a separate form. They are caused mainly by mycoplasmas and ureaplasmas. These microorganisms are often present in people who are sexually active.

Mycoplasmas and ureaplasmas do not always cause urethritis immediately after infection. They may not cause inflammation for a long time. But against the background of other STIs, including gonorrhea, these infections become more active. As a result, after the pathology is cured, the inflammation does not stop.

Further examination shows that the patient has ureaplasmosis or mycoplasmosis. PCR analysis helps identify these pathologies.

Bacteriological culture is used less frequently. It may be required in case of ineffective therapy to assess sensitivity to antibiotics.

Nongonococcal urethritis includes other inflammatory processes of the urethra that are caused by specific flora. It can be:

• chlamydia;
• ureaplasma and mycoplasma;
• Trichomonas;
• herpes.

Trichomonas can be detected by smear microscopy.

Other microorganisms are not detected in this way. Therefore, PCR remains the main diagnostic method. This method allows you to detect the DNA of bacteria, viruses or protozoa in the material under study.

When a pathogen is detected in a urethral smear, a diagnosis is made and treatment is prescribed. In addition, all of the listed pathologies with the exception of herpes can be diagnosed during cultural diagnostics.

The material is sown on a nutrient medium and the growth of colonies is observed. Another group of urethritis is nonspecific. These are inflammations of the urethra, which are caused by opportunistic flora. It is not always identified. Sometimes treatment is prescribed empirically, without further testing. If they are required, tank seeding is carried out. It allows you to identify the causative agents of nonspecific urethritis. The fact that a particular microorganism could cause inflammation is indicated by an increase in its population. In this case, it is determined in quantities of more than 10 4 CFU.

Interpretation of urethritis test results

Tests for urethritis must be interpreted by a doctor. Because they are interpreted as a whole.

Initially, a smear is given. It shows whether there is inflammation. The doctor judges this by the presence of leukocytes. In many cases, a smear can also detect trichomoniasis, candidiasis or gonorrhea.

Identification of at least one pathogen cell becomes the basis for making a diagnosis. At the next stage, they take a PCR test.

Results can be qualitative or quantitative. Qualitative studies are usually conducted. They answer whether the pathogen is present in the urethra.

Quantitative diagnostic tests are required for:

• ureaplasmosis;
• mycoplasmosis;
• candidiasis.

All these microbes can live in the urethra without causing inflammation. Therefore, only an increase in their population speaks in favor of diseases caused by these bacteria and fungi.

How to prepare for tests

Most tests for urethritis are done in the morning. Before this, you cannot be treated with antibiotics. Because the likelihood of false negative diagnostic test results increases.

Treatment is prescribed only after the diagnosis of urethritis is completed. 2 days before the study, you should not have sex, or use any topical antimicrobial agents.

Immediately before taking a smear, it is forbidden to urinate for at least 3 hours.

The exception is when there is copious discharge from the urethra. Then the test can be taken even 20-30 minutes after the last urination.

Women usually have vaginal smears taken at the same time. Because their infections can spread to the reproductive organs and cause vaginitis. Therefore, there are additional preparatory recommendations for women. For 2 days before diagnosis, they should not:

• use spermicides;
• use tampons;
• carry out douching.

Any diagnostic or therapeutic procedures in which the instrument penetrates the genital tract are prohibited. Do not use vaginal tablets or suppositories. Only then can you count on the most accurate results for diagnosing urethritis.

Tests for urethritis after treatment

Often, after completing a course of antibiotic therapy, the patient is asked to take tests again. This is necessary to understand whether he has been cured or not.

Tests are mandatory if urethritis is caused by a sexually transmitted disease.

Control laboratory tests can be prescribed at different times. They are usually done 2 weeks after stopping antibiotics.

For gonococcal infection, additional control is possible on the 2nd day after discontinuation of the drugs. For mycoplasmosis or ureaplasmosis, control tests can be taken 4 weeks after treatment. Control is mainly carried out using PCR. Sometimes a bacteriological examination is prescribed.

Which doctor treats urethritis in women

Urethritis in both women and men can be treated by a urologist. In addition, this is often done by a venereologist. Because the disease is often caused by venereal infections.

In women, the pathology can be treated by a gynecologist. Including if it is caused by a specific microflora. All these specialists are seen in our clinic. Here you can undergo diagnosis and treatment of urethritis.

Urethritis is a pathological inflammatory process of the mucous membrane of the urethra; it is one of the most common urological diseases not only in women, but also in men. High-quality, timely diagnosis is the key to successful and effective treatment, which minimizes the risk of developing dangerous complications. What tests for urethritis in women need to be taken before starting complex therapy?

What does the inspection show?

The first method of diagnosing urethritis is examination. Clinical diseases can be:

• redness of the external opening of the urethra,
• discharge from the urethra, crusts formed after they dry out,
• pain and discomfort when palpating the outer part of the urethra,
• redness of the labia.

Which doctor should I contact at the first symptoms of the disease? This can be not only a gynecologist, but also a urologist, dermatovenerologist. A woman must definitely see a gynecologist, who will send her a series of tests and studies. Only high-quality diagnostics makes it possible to accurately determine the causative agent of the disease and prescribe an effective course of treatment.

General urine analysis

A general urine test is the fastest and most informative diagnostic method that allows you to establish the fact of an inflammatory process in the urethra. In this case, the laboratory technician will detect a large number of leukocytes in the urine. For the most reliable result, urine collection must be carried out in the morning, this should be the first portion after a night's sleep (before this, you should not urinate for at least 4 hours).

Urine culture and antibiotic sensitivity testing

Bacteriological urine culture is the most accurate diagnostic method, allowing you to identify the causative agent of the disease and prescribe effective drugs. What is the essence of the technique?

The analysis is carried out in a microbiological laboratory. The urine sample is placed in a nutrient medium with favorable conditions for the infection to multiply. If there is an assumption that the patient has diarrhea, agar is used.

Bacteriological analysis not only confirms or refutes the presence of pathogenic microflora, but also shows the number of pathogenic microorganisms. This indicator is designated as CFU - colony-forming units. This assessment allows us to assess the severity and stage at which the inflammatory process is located.

How is the sensitivity of an infection to antibiotics determined? To do this, various antibacterial drugs are added to the environment with colonies of pathogenic microorganisms. And if the antibiotic stops or inhibits the growth of the infection, it will be effective in treating this case in that patient.

Please note that in order for the tests to be accurate and reliable, it is necessary to collect urine correctly. The collection is carried out in a special plastic container in an amount of three to five milliliters. The material must be delivered to the laboratory within 2 hours after collection.

Three-glass sample

This technique makes it possible to determine the exact localization of the inflammatory process, when it is necessary to establish an accurate diagnosis and carry out differential diagnosis between cystitis, urethritis and pyelonephritis.

How is the research conducted? Before the test, you should not urinate for 3-5 hours. Urine collection is carried out in the morning. The patient needs to collect urine in 3 containers (the first - 1/5 of the total volume, the second - 3/5, the third - 1/5). The material is sent to the laboratory, where a general urine test and a test using the Nechiporenko method are performed. The content of leukocytes in each portion of the material is assessed.

The results of the study are assessed as follows:

• increased content of leukocytes in the first portion – urethritis,
• in the third portion - posterior urethritis,
• in the first and third portions – a combination of anterior and posterior urethritis
• if an increased content of leukocytes is found in all portions, this is either cystitis or pyelonephritis.

Urethral swabs

A urethral smear is a reliable and accurate diagnostic method, since a sample of material for analysis is taken directly from the area affected by the infection. There are several types of smears:

• microscopic examination– examination of material samples under a microscope, which reveals an increased concentration of leukocytes,
• bacteriological analysis and antibiotic sensitivity testing is done in the same way as urine testing.

The material is collected using a special sterile spoon or probe. The material is placed in a special container and transferred to the laboratory. A woman should prepare for this study:

• within 12 hours before visiting the doctor you need to abstain from sexual intercourse,
• one week before the test, you should not take antibacterial drugs,
• You cannot urinate for 2 hours.

Analysis of urethral discharge

If, during the examination, the doctor saw that pus and mucus were being released from the urethra, the discharge can be used for analysis. In this case, the study is carried out in the same way as with smears.

Often when diagnosing urethritis, it is carried out PCR analysis– an effective method for determining a large number of pathogens of infectious urethritis. The technique is often used in the diagnosis of inflammatory processes in the urethra provoked by herpes viruses or chlamydia. A swab or urine sample is used as the material. In the laboratory, a polymerase chain reaction (PCR) is carried out, as a result of which the DNA of the pathogen is increased.

Urethroscopy

Urethroscopy is a study that involves inserting special equipment into the urethra to examine the mucous membrane of the urethra. Preparation for ureteroscopy is carried out in several stages:

• before the study, the patient is usually prescribed a weekly course of antibiotics,
• an antibiotic injection is given immediately before the procedure to prevent the infection from spreading,
• You must urinate before the procedure.

Urethroscopy allows:

• conduct an examination and evaluate the condition of the urethra from the inside,
• perform a biopsy,
• remove scar, tumor, eliminate narrowing of the urethra.

Additional types of research

When diagnosing urethritis, the specialist may also refer the patient for additional studies:

1. Ultrasound diagnostics of the pelvic organs.
2. Urethrocystoscopy makes it possible to examine not only the urethra, but also the bladder.
3. Victory cystourethrography is an x-ray diagnostic type in which a radiopaque substance is injected into the bladder.

Sources:

Lopatkin N.A.: “Guide to Urology”, 1998.

Inflammation of the urethra is considered one of the most unpleasant and at the same time common diseases. In medicine, this phenomenon is called urethritis, and it is not a life-threatening condition, but its symptoms cause severe discomfort and interfere with a person’s normal lifestyle.

Causes of the disease

According to statistics, the majority of patients are men, but urethritis in women, unfortunately, is also quite common. Often people independently diagnose themselves and begin treatment, but the problem is that this disease is very similar to cystitis.

A significant difference between the second is the pain that accompanies the entire process of urination and may not last long after its completion. Moreover, these two diseases often occur simultaneously.

Causes of inflammation:

• Reduced immunity;
• Hypothermia;
• Stones in the kidneys;
• The presence of sexually transmitted diseases, sexually transmitted infections;
• Poor nutrition;
• Malignant tumors of the urethra;
• Allergy;
• Venous congestion in the pelvis;
• Early sexual intercourse;
• Failure to comply with hygiene rules;
• Injuries to the genital organs;
• Alcoholism;
• Psycho-emotional overload, stress;
• Pregnancy.

Symptoms of urethritis in women

Often, the symptoms of the disease in females are less pronounced than in males. This is due to the difference in the structure of the genitourinary system. In men, the urogenital canal is narrower and longer, so they are more susceptible to inflammatory processes of various etiologies.

The most common signs of the disease are:

1. Pain and burning during urination;
2. Discharge of pus from the urethra. The color of the discharge directly depends on the pathogen, ranging from dark yellow to whitish;
3. Redness of the external genitalia;
4. Itching during menstruation.

With chronic urethritis, rare pain in the lower abdomen occurs, this applies not only to the period of exacerbation. Most often, in females, the pathology occurs without pronounced symptoms, so its diagnosis is sometimes complicated.

The disease becomes chronic if there is no treatment, or with incorrect and untimely therapy. After about three weeks, the acute form may become chronic. The main symptoms disappear and appear only after hypothermia, alcohol abuse, strong psycho-emotional arousal and at the time of sexual intercourse.

Urethritis has infectious and non-infectious origin. The most common is gonorrheal urethritis, which is sexually transmitted. Its signs appear through infection. Another common cause is chlamydia.

Non-gonorrheal forms of the disease

These include trichomonas and candidiasis urethritis.

The first infection occurs both sexually (through unprotected sexual intercourse) and through everyday life (carious teeth, tonsillitis, chronic sinusitis, tuberculosis, etc.). Symptoms of acute trichomonas urethritis in women include the appearance of whitish foamy discharge one to two weeks after infection, as well as itching in the urethra.

But often this form occurs hidden. Treatment of trichomonas urethritis usually involves the use of metronidazole (Trichopol) for 8-10 days.

Candidal urethritis occurs when the canal is damaged by yeast fungi of the genus Candida. This form of the disease is quite rare and occurs mainly due to long-term use of antibacterial agents in the treatment of other pathologies. Once the diagnosis is confirmed, antibiotics are stopped.

The first manifestations of pathology occur at the onset of menopause, menstruation, or the abolition of oral contraceptives. The doctor decides how to eliminate inflammation, guided by diagnostic indicators and the picture of the disease of a particular patient.

Diagnostics

During the examination, the doctor may detect hyperemia of the external opening of the urethra and surrounding tissues, and discharge from the urethra. The patient feels pain on palpation.

The following activities are required:

• General analysis of urine and blood;
• Extended study of urine according to Nichiporenko;
• Bacteriological analysis, which will allow you to accurately determine the type of etiological pathogen; at the same time, a test is carried out for its sensitivity to antibiotics;
• Analysis of bacteriological material (scraping from the walls of the urethra) using the PRC method;
• Testing urine for Mycobacterium tuberculosis.

Sometimes urethroscopy is performed - an endoscopic examination of the urethral mucosa, which allows you to take scrapings and eliminate scars and strictures. An ultrasound examination may also be prescribed to assess the general condition of the pelvic organs.

Treatment of urethritis in women

1. After diagnosis, antibacterial agents are prescribed such as: ciprofloxacin, pefloxacin, amoxiclav, norfloxacin.
2. Antibiotics are mainly prescribed in the form of tablets, but other options are also allowed: intravenous and intramuscular injections, intravaginal suppositories and installations (infusion of a substance through a catheter into the urethra).
3. They may prescribe either one type of antibiotic or a combination of two, three or even four drugs.
4. Procedures such as baths and rinses using calendula, chamomile, and potassium permanganate help to get rid of discomfort. Purely feminine remedies include warming applications, tampons impregnated with anti-inflammatory and antibacterial substances, and vaginal suppositories.
5. Drugs for acute urethritis in women include antihistamines, for example, the most common are miramistin, tavegil and suprastin. If chlamydia is detected at the same time, then azithromycin and doxycycline are prescribed.

How to get rid of pathology

• Antibiotics and anti-inflammatory drugs cannot completely get rid of the disease, especially those caused by viruses and fungi. It is necessary to simultaneously increase the body's resistance to such infections and restore the normal microflora of the female genital organs.

Therefore, the doctor prescribes drugs that stimulate the immune system: thymalin, Gepon, cycloferon, phlogenzyme, antioxidants, ribomunil, PP and B vitamins.

• Treatment of the chronic form is a longer process. Antibiotics such as chloramphenicol and gentamicin are often prescribed for chronic urethritis in women. The sooner you start therapy, the faster the positive effect will occur.

The duration of treatment varies in each individual case and can last several weeks. Antiseptic urethral lavages and vitamin and mineral supplements are also prescribed.

• If the causative agent is a gonococcal infection, an antibiotic is installed in the urethra. In the presence of granulation, installation with a solution of silver and collargol is used, as well as bougienage and cauterization of the urethra with a solution of silver nitrate (10-20%), but only with severe narrowing.
• The chronic chlamydial form is treated with antibiotics and immunomodulators, probiotics, interferon preparations, enzyme therapy, hepatoprotectors (for the liver), vitamin therapy, and antioxidants.

Symptoms of inflammation of the urethra may resemble other diseases of the genitourinary system. But the treatment of different pathologies differs significantly from each other. Therefore, it is very important to correctly identify the existing disease (urethritis or something else). Laboratory and instrumental diagnosis of urethritis helps with this. Which methods are the most informative, how to prepare for them to obtain an accurate result, and how are they carried out? Let's talk about this in more detail.

How to detect urethritis using laboratory methods?

Laboratory methods help determine urethritis. They occupy the main place in the diagnosis of this pathology. The main methods that are used to identify urethritis are as follows:

• Bacterioscopic - examination of the taken material under a microscope.
• Bacteriological - sowing material on special media and studying the appearance of the grown colonies.
• Serological - determination of antibodies (immunoglobulins of different classes) to the most common and probable pathogens of urethritis. Immunoglobulins can be systemic (class G and M) and local (class A, they are synthesized locally in the mucous membrane).
• PCR diagnostics - detection in the blood or other biological media (urine, urethral discharge, cervical canal) of certain genetic sequences characteristic of a particular pathogen.
• General clinical - examination of urine and blood using standard methods to assess the presence and degree of the inflammatory process. These tests are prescribed to almost every person who seeks medical help.

To establish the correct diagnosis of urethritis (in the presence of suspicious clinical signs or inflammatory changes in a general clinical urine test), it is necessary to first examine the discharge from the urethra. But some factors can distort the reliability of this analysis, so doctors adhere to certain rules when collecting material.

How to prepare for urethral analysis and how it is performed

The rules for obtaining discharge from the urethra differ for women and men.

For women, these rules include:

• collection of material no earlier than 1 hour after urination;
• use a sterile cotton swab. If there is no discharge, then a special endobrush (a brush like a small brush), which is turned clockwise several times, is inserted into the urethra to a depth of 2-4 cm.

For men, the collection rules are as follows:

• 2 hours or more must have passed since the last urination;
• insert the endobrush into the urethra 2-4 cm and rotate 2-3 times clockwise.

In cases where urethritis occurs with unexpressed symptoms, and in chronic forms, taking the discharge using an endobrush is not always informative. Therefore, for such patients, doctors carefully scrape the mucous membrane using a Volkmann spoon. This procedure is well tolerated; minor discomfort may be felt during it.

The resulting material is either subjected to microscopy (bacterioscopic method) or sown on media (bacteriological method). Using a microscopic examination, it is possible to quickly and easily identify Trichomonas and gonococci (the method is less sensitive for other pathogens). But their absence in a smear does not mean that they are excluded as a cause of urethritis. In this case, if there are suspicious clinical symptoms, polymerase diagnostics is indicated. The detection of more than 5 leukocytes in one field of view in a smear is a reliable sign of an inflammatory process in the urethral zone, which is called urethritis.

Thus, using microscopy you can diagnose:

• fact of urethritis (presence of inflammation);
• its cause (a specific pathogen, especially if it is gonococcus or Trichomonas), which affects further tactics of patient management.

The advantage of bacteriological diagnosis of urethritis is the ability to determine the sensitivity of the causative microbes to antibiotics, so that the doctor can initially prescribe the one that will be most effective for a given patient.

Urine tests

Initially, if there are complaints of increased urination and pain, the doctor assumes urethritis, and therefore prescribes a general urine test. If it (or the Nechiporenko analysis) reveals large numbers of leukocytes or bacteria, a three-glass test is recommended.

A 3-glass test helps to conduct a topical diagnosis of damage to the urinary system, i.e. determine which organ is specifically inflamed.

It can also be used to evaluate:

• number of pathogens in 1 ml of urine;
• their appearance;
• sensitivity to antibacterial drugs.

This test is especially informative if the cause of the disease is opportunistic microbes (if other methods do not detect them):

• staphylococci;
• streptococci;
• Proteus;
• E. coli, etc.

Using this analysis, it is possible to understand in which part of the urinary system inflammation has developed. The results are interpreted as follows:

• urethritis is when pathological changes are detected in the first portion of urine;
• prostatitis and cystitis lead to the appearance of a large number of leukocytes in the second portion of urine;
• pyelonephritis - inflammation of the kidneys - causes the appearance of leukocytes in all three samples.

Urethroscopy

In some cases, to clarify the nature of the mucosal lesion, the doctor may perform urethroscopy. This is an endoscopic method performed under anesthesia. Most often, modern highly effective local anesthetics are used; Previously, anesthesia was used for this, but due to its side effects, this method of pain relief has now been abandoned.

A special thin probe with a video camera is inserted into the lumen of the urethra, and an image is displayed on the screen. Such diagnostics are carried out to establish the characteristics of damage to the urethra, as well as in the presence of prostatitis or inflammation of the seminal vesicles.

Urethroscopy can be performed on both men and women. There are 2 varieties of this method:

• irrigation urethroscopy - to improve visualization of the urethra, saline solution is injected into the bladder;
• dry urethroscopy - instead of liquid, the doctor fills the bladder with gas as the urethroscope advances.

Depending on how the urethritis proceeds, the urologist chooses the most informative method from those considered. In addition to inflammatory lesions of the urethra, using urethroscopy, the doctor can identify:

• foreign bodies;
• cysts;
• tumor lesions;
• dystrophic processes of the mucous membrane, often developing in women during menopause.

The method has virtually no contraindications. Only advanced urethritis limits its use, because due to the pronounced inflammatory process when inserting a urethroscope, there is a very high risk of rupture of the urethra. In this case, diagnosis is based only on the results of laboratory tests.

For several days after urethroscopy, you may experience some discomfort associated with:

• with the presence of light bleeding from the urethra;
• with pain when going to the toilet “in a small way”.

If after the procedure the body temperature rises, the stream of urine weakens, or there is bleeding that does not stop, you should urgently go to a urologist. These symptoms may indicate possible complications of urethroscopy, which are not free from any method of invasive (associated with the direct penetration of equipment into the human body) diagnostics, and urethroscopy is no exception.

Diagnosis of chlamydial urethritis

To identify chlamydial urethritis, the following methods can be used:

1. Bacterioscopic, in which the presence of chlamydia is determined in tissues (they are located intracellularly). The method for chlamydia is low-sensitive - only 10-20% of patients with chlamydial urethritis can detect this microorganism. Immunofluorescence increases the information content of the method. To do this, the drug is treated with antibodies and then exposed to fluorescent light. In the presence of chlamydia, a yellow-green glow is detected. This type of bacterioscopic method is quite informative. Thus, in approximately 70-75% of infected patients, the cause of urethritis can be determined.
2. Bacteriological method. It consists in the fact that the resulting material (discharge from the urethra) is introduced into a cell culture. Artificial nutrient media cannot be used for this, because Chlamydia does not grow on them. The method is highly sensitive - in 75-95% of people with chlamydial urethritis, causative microorganisms are detected. Due to its labor-intensive nature, it is not widely used in clinical practice. It is usually used to monitor complete healing. It will not be informative if it is carried out while taking antibiotics or within 1 month after the end of antibacterial therapy.
3. Serological methods. The titer of class G immunoglobulins to chlamydia is determined in the blood if there is a generalized form of infection or the material cannot be obtained, because organs are located in places difficult to reach for non-invasive diagnostics (for example, prostate, testicles, ovaries, etc.). But to identify urethritis, local immunity is studied - the titer of immunoglobulin A in the urethral canal is determined. However, the method has two drawbacks. It is not suitable for diagnosing acute chlamydial urethritis, because In response to infection, antibodies do not appear immediately, but after some time. The method cannot be used to assess whether the patient is cured or not, due to the fact that the immunoglobulin titer remains elevated for a long time. Serological methods are especially valuable for identifying sluggish and asymptomatic forms of urethritis, but when there is damage to the pelvic organs. In this case, the method is informative in 95% of cases of infection.
4. PCR diagnostics. The sensitivity of this method is almost 100%, i.e. it allows us to identify almost all patients infected with chlamydia. Various biological materials can be studied. But for men, they usually use the first portion of urine obtained immediately after waking up (there is no need to wash yourself, so as not to distort the results of the analysis), and for women, cervical mucus (if chlamydia is detected in it, then it is also in the urethra). The main advantage of PCR diagnostics is the simultaneous detection of several pathogens of urethritis in the same sample of biological material. Thus, in urine or cervical secretions, in addition to chlamydia, different types of mycoplasmas and ureaplasmas can be detected. However, there is one drawback. PCR cannot be used to confirm complete destruction of chlamydia in the body (cure of infection). This is due to the fact that PCR detects even non-viable fragments of DNA and RNA, which remain in the body for 2-3 months after the end of successful antibacterial therapy.

The diagnosis of gonorrheal urethritis in most cases is established based on the results of a microscopic examination of the discharge of the urethra. In this case, diplococci are found, which resemble a coffee bean consisting of 2 halves. They:

• located intracellularly,
• have different shapes and different colors,
• the outside is covered with a capsule.

To detect these pathogens of urethritis, a bacteriological examination is also carried out. The taken material is sown on meat-peptone media, and then the growth pattern on them is studied.

Diagnosis of gardnerella urethritis

Gardnerella urethritis can be detected by bacterioscopic methods. The taken material is examined unstained and after Gram staining.

In the first case, the sign that indicates gardnerellosis is the presence of key cells. They are squamous epithelial cells lining the urethra, to which gardnerella bacteria are attached.

In the second case (when the preparation is stained), this infection is indicated by:

• individual leukocytes, randomly scattered in the fields of view;
• a large number of bacteria that have a negative Gram stain, with a considerable part of them attached to epithelial cells.

Diagnosis of mycoplasma and ureaplasma urethritis

It is not easy to identify urethritis caused by mycoplasmas or ureaplasmas. Widespread microscopic diagnostic methods turn out to be uninformative due to the large species diversity of these bacteria.

Cultural methods are also not always informative, because even if there is growth on nutrient media, this does not indicate infection. Mycoplasmas and ureaplasmas can be opportunistic inhabitants of the urinary tract of men and women, without causing the development of an inflammatory reaction.

Therefore, at present, urethritis, which is presumably associated with these microorganisms, is an indication for PCR diagnostics.

Diagnosis of herpetic urethritis

Urethritis caused by herpes viruses type 1 or 2 is diagnosed using one of the following methods:

• microscopy of smears taken from local rashes and the urethra. At the same time, the laboratory assistant determines a large number of giant cells and intracellular inclusions;
• PCR method to detect viral DNA;
• immunofluorescence - a bright green glow is detected in smears.

Diagnosis of fungal urethritis

Fungal urethritis is easy to diagnose. During a microscopic examination of the smears taken, the laboratory technician sees a large number of micellar filaments located in thick mucus. There is no point in using more expensive methods to diagnose candidiasis, because... microscopy is highly informative.

Diagnosis of Trichomonas urethritis

Trichomonas urethritis does not present difficulties for diagnosis, because has typical symptoms (more details in the section “Symptoms of Urethritis”). However, the following methods help to finally determine the causative microorganism (Trichomonas):

• bacterioscopy - even in an unstained preparation, a laboratory assistant can easily identify Trichomonas;
• bacteriological examination, but it is less common because microscopy is quite informative.

Conclusion

The presence of symptoms of urethritis is an indication for laboratory and/or instrumental diagnostics. Its task is to confirm inflammation of the urethra, as well as to identify its cause (a specific microorganism). This helps the doctor carry out differentiated treatment and cure the patient’s urethritis.

Inflammation of the walls of the urethra (urethra). Signs include pain, pain and burning when urinating, pathological discharge from the urethra, the nature of which depends on the causative agent of the disease. In complicated cases, the inflammatory process also spreads to neighboring pelvic organs: the prostate, bladder and scrotal organs. Another consequence of urethritis is a narrowing (stricture) of the urethra or its complete adhesion. An important point in diagnosing urethritis is determining its etiology. For this purpose, a bacteriological examination of urine and urethral smear is carried out. Treatment of urethritis is carried out in accordance with its cause (antibiotics, metronidazole, antimycotic drugs); if adhesions develop, urethral dilation is indicated.

General information

– inflammation of the wall of the urethra. Usually has an infectious nature. It extremely rarely develops without the presence of an infectious agent (radiation, toxic, allergic urethritis). Sometimes the cause of the disease is injury during a diagnostic or therapeutic procedure (catheterization of the bladder in men, administration of drugs, etc.).

Infectious urethritis is divided into two large groups: specific and nonspecific. A specific inflammatory process in the urethra is caused by pathogens of sexually transmitted diseases (gonococcus, trichomonas, chlamydia, ureoplasma, mycoplasma). The cause of the development of nonspecific inflammation of the urethra is opportunistic flora (staphylococcus, streptococcus, fungi, Proteus, E. coli).

There are primary and secondary urethritis. With primary inflammation of the urethra, the infection penetrates directly into the urethra, most often through sexual contact with a partner who has a sexually transmitted disease. Secondary urethritis occurs when infection spreads from an inflammatory focus located in another organ (pelvic organs, seminal vesicles, bladder, prostate gland).

Bacterial urethritis

The cause of the development of nonspecific inflammation of the urethra is a conditionally pathogenic flora. Microorganisms penetrate the urethra during prolonged bladder catheterization in women and men, transurethral endoscopic manipulation, or sexual contact with a casual partner.

• Primary bacterial urethritis

There are acute and chronic bacterial urethritis. The course of an acute nonspecific inflammatory process differs from the clinical picture of gonorrheal urethritis. The length of the incubation period may vary. Local signs of inflammation are not so pronounced. Characterized by pain when urinating, itching, burning, purulent or mucopurulent discharge, slight swelling of the urethral mucosa and tissues surrounding the external opening of the urethra.

It must be remembered that based on the clinical picture and the nature of the discharge, it is impossible to carry out a differential diagnosis of bacterial and gonorrheal urethritis. The diagnosis is made only upon receipt of laboratory test data confirming the absence of gonococci: culture for the presence of gonorrhea, PCR diagnostics, etc.

Chronic inflammation of the urethra usually has few symptoms. There is slight itching and burning when urinating, scanty mucous discharge and high resistance to therapy. The short and wide urethra in girls and women allows infection to easily enter the bladder, causing cystitis, which is diagnosed by ultrasound of the bladder. In men, chronic urethritis in some cases is complicated by colliculitis (inflammation of the seminal tubercle). The seminal tubercle is the site of exit of the prostate ducts and vas deferens. Its inflammation can lead to hemospermia and ejaculation disorders.

• Secondary bacterial urethritis

The infectious agent enters the urethra from a local source of infection (in the pelvic organs, bladder, prostate, seminal vesicles) or during an infectious disease (tonsillitis, pneumonia). Secondary nonspecific urethritis is characterized by a long latent course. Patients complain of mild pain when urinating, scanty discharge from the urethra of a mucopurulent nature, more pronounced in the morning. Children often have no pain when urinating. On examination, hyperemia and gluing of the sponges of the external opening of the urethra are revealed.

When conducting a two- or three-glass test, the first portion of urine is cloudy and contains a large number of leukocytes. In the second portion, the number of leukocytes decreases, and in the third, as a rule, it corresponds to the norm. To preliminary determine the nature of the microflora, a bacterioscopic examination of the discharge from the urethra is carried out. To clarify the type of infectious agent and its sensitivity to antibacterial drugs, a culture of the discharge or urethral wash is performed.

• Treatment of bacterial urethritis

Modern urology has effective methods of treating nonspecific urethritis. Treatment tactics are determined depending on the type of pathogen, the severity of symptoms, and the presence or absence of complications. The combination of urethritis with cystitis is an indication for complex therapy. In case of a chronic nonspecific process, the use of antibacterial drugs is supplemented by instillation of solutions of collargol and silver nitrate into the urethra, and measures are taken to normalize the immune system. The result of therapy for secondary urethritis is largely determined by the effectiveness of treatment of the underlying disease (urethral stricture, vesiculitis, prostatitis).

Gonorrheal urethritis

As a rule, it develops as a result of sexual intercourse with an infected partner, less often - through indirect contact through towels, sponges, linen, chamber pots. The reason for the development of infection in children may be living together with an adult patient or using a shared toilet.

• Symptoms and clinical course

The first symptoms of the disease appear 3-7 days after infection. In some cases, it is possible to increase the incubation period to 2-3 weeks. Depending on the duration of the infection, acute (disease duration less than 2 months) and chronic (disease duration more than 2 months) gonorrhea is distinguished.

Acute gonorrheal urethritis usually begins suddenly. There appears abundant yellowish-gray purulent creamy discharge from the urethra, pain, burning and pain when urinating. When the inflammatory process is localized in the anterior urethra, the patient's condition is satisfactory. The spread of inflammation to the posterior part of the urethra is accompanied by hyperthermia up to 38-39 ° C and general signs of intoxication. Pain when urinating becomes more pronounced.

Chronic gonorrheal urethritis develops:

1. in patients with untreated or incompletely cured acute inflammation of the urethra of gonococcal etiology;
2. in patients with weakened immune systems;
3. when the prostate and posterior part of the urethra are involved in the inflammatory process.

The chronic inflammatory process is characterized by mild symptoms. Patients are concerned about itching and slight burning in the urethra. The onset of urination is accompanied by a mild tingling pain. Discharge from the urethra is scanty, mucopurulent, mainly in the morning. Examination of smears indicates the presence of gonococci and secondary microflora.

In chronic gonorrheal urethritis, the ducts of the paraurethral glands are often involved in the process. Inflammation impedes outflow, leading to blockage of the ducts, the development of infiltrates, abscesses and encysted cavities. The patient's general condition worsens, with sharp pain when urinating.

• Diagnosis

Microscopy of urethral discharge is performed. The diagnosis is confirmed by the presence of gonococci (Neisseria gonorrhoeae) - gram-negative bean-shaped aerobic diplococci. The standard examination consists of two stages and includes staining using the Gram method and brilliant green (or methylene blue).

• Differential diagnosis

Diagnosis is usually not difficult due to the presence of characteristic symptoms (pain during urination, purulent discharge from the urethra). A differential diagnosis of gonorrheal urethritis and inflammation of the urethra of another etiology (Trichomonas, non-specific urethritis, etc.) is carried out. The diagnostic criterion is the results of bacterioscopic examination. The history reveals the presence of sexual contact with patients with gonorrhea.

• Treatment

Treatment of gonorrheal urethritis is carried out by venereologists. Recently, increasing resistance of gonorrhea pathogens to penicillin has been observed. The greatest effectiveness is observed when taking cephalosporins and fluoroquinolones. The patient is advised to drink plenty of fluids. Alcohol, fatty and spicy foods are excluded from the diet.

Chronic gonorrheal urethritis is an indication for combination therapy. The patient is prescribed antibacterial drugs and local treatment. When granulation tissue grows and cellular infiltration (soft infiltrate), solutions of collargol and silver nitrate are instilled into the urethra. If cicatricial-sclerotic processes predominate (hard infiltrate), bougienage of the urethra is performed with metal bougie. Severe granulations are cauterized once a week with a 10-20% solution of silver nitrate through the urethroscope.

• Cure criteria

7-10 days after completion of treatment, a bacterioscopic examination of the urethral discharge is performed. If gonococci are not detected, a combined provocation is performed: biological (pyrogenal or gonovaccine intramuscularly) and chemical (injection of 0.5 solution of silver nitrate into the urethra). Mechanical (anterior urethroscopy or bougie insertion into the urethra), thermal (warming with inductothermic current) and nutritional (drinking alcohol and fatty foods) provocation are also used.

Then, every day for three days, the secretion of the prostate gland, urine strings and smears from the urethra are examined. In the absence of leukocytes and gonococci, the provocation is repeated after 1 month. After another month, a third and final control study is carried out. If there are no clinical manifestations, and gonococci are not detected by culture and bacterioscopy, the patient is removed from the register. Acquired immunity does not develop with gonorrhea. A person who has had gonorrheal urethritis in the past can become infected again.

• Forecast

With proper, timely treatment of fresh gonorrheal urethritis, the prognosis is favorable. When the process becomes chronic and complications develop, the prognosis worsens. Gonococcal endotoxin has a sclerosing effect on the tissue of the urethra, which can lead to the formation of strictures (usually multiple) in the anterior part of the urethra. Frequent complications of chronic inflammation of the urethra with gonorrhea are vasiculitis, epididymitis, chronic prostatitis. The outcome of prostatitis can be impotence, the outcome of epididymitis can be infertility as a result of cicatricial narrowing of the vas deferens.

Trichomonas urethritis

• Symptoms and diagnosis

Symptoms of Trichomonas urethritis appear 5-15 days after infection. Characterized by mild itching, moderate whitish foamy discharge from the urethra. The diagnosis is confirmed by the detection of trichomonas (Trichomonas vaginalis) in native and stained preparations. Examine urethral discharge, urethral scraping or centrifugate of the freshly released first portion of urine. In native preparations, the movements of Trichomonas flagella are clearly visible.

Often, when studying the native drug (especially in men), motile Trichomonas cannot be detected. The reliability of the study can be increased by using additional methods (microscopy of stained smears, culture examination).

• Treatment

Specific anti-trichomonas drugs are used, the most effective of which are metronidazole, ornidazole and tinidazole. The treatment regimen depends on the patient’s condition, the severity of symptoms, the presence of complications and concomitant sexually transmitted infections. Self-medication is unacceptable, as it can contribute to the transition of an acute process to a chronic one.

In order to prevent re-infection, the patient's regular sexual partner is simultaneously treated. During therapy and for one to two months after its completion, the patient is recommended to drink plenty of fluids and exclude spicy foods and alcohol from the diet. For resistant chronic inflammation, both general and local therapy are prescribed. For 5-6 days, the patient is given instillations of a 1% solution of trichomonacid for 10-15 minutes.

In some cases, trichomoniasis in men is asymptomatic or accompanied by extremely scanty symptoms. Patients are often unaware of their disease and spread the infection to their sexual partners. In 15-20% of cases with chronic trichomonas urethritis, prostatitis develops, worsening the patient’s condition and making treatment more difficult.

Chlamydial urethritis

A number of serotypes of Chlamydia trachomatis act as infectious agents. Chlamydia are located intracellularly, which is typical for viruses, but the presence of certain characteristics (DNA, RNA, ribosomes, cell wall) allows these microorganisms to be classified as bacteria. Epithelial cells of the urethra, cervix, vagina and conjunctiva are affected. Transmitted sexually.

Chlamydial urethritis is usually sluggish and asymptomatic. The inflammatory process in the urethra is in some cases accompanied by joint damage and conjunctivitis (urethro-oculo-synovial syndrome, Reiter's disease). The diagnostic criterion is the presence of semilunar intracellular inclusions in a colored scraping from the urethra.

Treatment. Problems in the treatment of chlamydia are associated with insufficient permeability of cell membranes to most antibiotics. Repeated manifestations are typical after courses of treatment. To increase effectiveness, broad-spectrum antibiotics are combined with corticosteroid drugs (dexamethasone, prednisolone). The maximum dose of prednisolone is 40 mg/day, the course of treatment is 2-3 weeks. During the course of therapy, the dose of hormones is gradually reduced until complete withdrawal.

Candidiasis urethritis

The causative agent is yeast-like fungi. Inflammation of the urethra of fungal etiology is rare and is usually a complication after long-term treatment with antibacterial drugs. Sometimes it develops after sexual contact with a woman who suffers from candidiasis vulvovaginitis. The risk of infection increases with a history of inflammatory diseases or damage to the urethra.

Candidiasis urethritis is characterized by mild symptoms. Patients complain of a slight burning sensation, mild itching, and scanty whitish discharge from the urethra. Microscopy in an acute process reveals a large number of yeast-like fungi. In case of chronic inflammation, mycelial threads predominate in the sample. Therapy consists of discontinuing antibacterial drugs and prescribing antifungal agents (nystatin, terbinafine, fluconazole).