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Desquamative urethritis. How to treat urethritis in men

Any inflammatory processes in the organs of the urinary tract, as a rule, are accompanied by extremely unpleasant symptoms, which forces the patient to consult a doctor quite early. However, if the disease occurs latently or subacutely (low-grade), then there is a risk of it becoming chronic, requiring very long and sometimes ineffective treatment.

Urethritis is a pathological process of an inflammatory nature, localized in the mucous layer of the urethra (urethra), which has an infectious or non-infectious nature of its origin.

Before talking about the causes of urethritis, its variants clinical course and principles of treatment, it is worth mentioning that the disease is a very pressing problem among doctors of various specialties. Gynecologists, venereologists, urologists and others deal with the treatment of the disease.

The disease is most often registered among segments of the population with a low socio-cultural level of development, this fact is explained by the characteristics of their sex life and lack of commitment to timely diagnosis.

Most often, the disease occurs against the background of sexually transmitted infections in the absence of barrier contraception measures

Classification

First of all, the disease is usually divided into two large groups (the classification is based on the affiliation of infectious agents with the origin pathological process).

Infectious urethritis:

specific variant of the disease: trichomonas; tuberculous; gonorrheal.
nonspecific variant of the disease: associated with bacterial agents (mycoplasma, ureaplasma, gardnerella, etc.); associated with viral agents (herpetic, candylomatous, etc.); chlamydial; fungal; mixed.

Non-infectious urethritis:

traumatic;
allergic;
exchange;
congestive urethritis.

The inflammatory process in the urethra of any etiology is extremely unpleasant

There is a separate classification of the disease, according to which the process is divided into gonococcal and non-gonococcal urethritis. However, this division of the disease is considered not entirely correct and is extremely rarely used among doctors.

It is also worth highlighting inflammatory processes in the urethra that arise against the background of disturbed psychosomatics in the patient (psychogenic, that is, caused by mental disorders, long-term depression, nervous overstrain). There are also urethritis, which are associated with improper medical tactics(iatrogenic).

Morphological characteristics of urethritis

The chronic form of the disease can occur in several morphological variants:

Follicular urethritis. It is characterized by blockage of the excretory ducts of the Littre glands (located around the urethra), and the accumulation of inflammatory exudate, capable of forming cysts.
Infiltrative urethritis. It develops when a pathogenic pathogen penetrates under the mucous layer of an organ. Pathological restructuring of the epithelial layer occurs (its metaplasia).
Granulation urethritis. If the process does not work for a long time adequate therapy, then there is a gradual multiplication of infectious agents in the thickness of the epithelial layer, in places ulcers and granulation-type growths are formed.
Desquamative urethritis. This form of the disease is characterized by the involvement of the entire urethra in the pathological process, the mucous layer of which undergoes keratinization (observed in gonorrheal urethritis).

Causes

Infectious factors

A larger percentage of cases of urethritis are, one way or another, associated with the proliferation of infectious agents and their effect on the patient’s body.

In women, the disease can begin when pathogenic properties are activated in microorganisms that are representatives of the “natural” microflora of the vagina and rectal lumen. We are talking about pathogens such as Klebsiella, Esherichia coli, Enterobacter, Proteus and others.

Most often, the process occurs against the background of enterococcus fecalis (if the rules are not followed intimate hygiene)

For males, the disease is typically associated with Chlamydia trachomatis and Neisseria gonorrhoeae. If none of these microorganisms are detected in the test materials, then a diagnosis of non-chlamydial non-gonococcal urethritis is made.

It occupies one of the leading places among all causes of the disease. In approximately 1/3 of patients, the process is asymptomatic, while they are active bacteria carriers.

Among the nonspecific pathogens of the disease, it is worth highlighting mycoplasma and ureaplasma, which can become a trigger for the development of quite serious illnesses not only the urethra, but also Bladder and kidneys. In approximately 1/4 of men, nongonorrheal urethritis is associated with the active reproduction of these microorganisms.

If viral agents are introduced into the organs of the reproductive tract, which is observed during intimate relationships, a pathological process of the corresponding etiology is launched. Among the main pathogens, it is worth highlighting herpes simplex virus type 2 ( herpetic urethritis) and condillomatosis. Most often, the clinical picture is observed only during primary infection, and then the disease passes into a latent form, accompanied by periods of remission and exacerbation.

Not long ago, scientists established the involvement of Gardnerella vaginalis in the occurrence of the disease, which is transmitted exclusively through sexual contact and is isolated from the urethral secretions of both men and women.

Against the background of immunodeficiency conditions, fungal urethritis is most often diagnosed; long-term antibiotic therapy or the use of hormones and cytostatics can also contribute to its occurrence.

Non-infectious factors

As mentioned above, the disease can be caused not only by infectious agents, but also by a number of other reasons:

traumatic effect on the urethral epithelium, as a result of which the protective ability of the mucous membrane is disrupted (against the background of urethroscopy, catheterization or cystoscopy of the bladder, after the introduction foreign bodies into the lumen of the urethra, after difficult childbirth, etc.);
obstruction of the urethra due to strictures or its pathological bends (this leads to stagnation of urine, which is a provoking factor for the development inflammatory process);
allergic urethritis occurs with severe allergies to various chemicals, food, cosmetics, medications etc.;
congestion in the pelvic organs in women (against the background of varicose veins), in the penis or scrotum in men (congestive urethritis);
pronounced metabolic disorders leading to changes in the acidity of urine, the formation of sand and stones in the urinary tract (uraturia, oxalatry and others);
oncological processes in the urethra of a benign or malignant nature.

Urolithiasis often causes inflammation in the urethra

Predisposing factors

Among the predisposing causes, one way or another, influencing the development of the pathological process, it is necessary to highlight:

concomitant inflammatory processes in the bladder and kidneys (cystitis, pyelonephritis and others), prostate gland (prostatitis) and others;
low immune status of the patient;
long and frequent use alcohol, tobacco use;
low level social development and uncontrolled sexual intercourse;
use of antibiotics, glucocorticoid hormones or cytostatics;
sedentary lifestyle, low level of daily physical activity;
failure to comply with intimate hygiene rules, use of personal products (for example, infection of girls by infected mothers using a shared washcloth or towel).

Complications

If the disease is not diagnosed in time, or the treatment provided is inadequate, then there is a risk of complications of the process.

Among the most common adverse outcomes of the disease are the following:

inflammatory processes in the prostate (prostatitis), epididymitis, vesiculitis;
strictures in the lumen of the urethra;
inflammatory processes in organs reproductive system in women, which very often becomes the cause female infertility, obstruction fallopian tubes, and ectopic pregnancy(endometritis, cervicitis and others).

Diagnostics

The basis for diagnosing urethritis is represented by several research methods:

The bacterioscopic method is the fastest. The essence of the procedure is a microscopic examination of the discharge from the lumen of the urethra (native and pre-stained preparation). Using this method, microbes (primarily gonococcus), protozoa, as well as all cellular elements and their increase (leukocytes, epithelial cells and others) can be detected in the patient.
The bacteriological method is necessary to accurately determine the nature of the infectious agent. To do this, the substrate is sown on nutrient media. In addition to growing a pure culture of the pathogen, its antibacterial sensitivity is assessed, which is necessary for adequate treatment.
Serological methods make it possible to detect in the patient’s body antibodies developed to the antigens of the pathogen, as well as the DNA of the microorganism (ELISA, PCR, RSK and others).

The requirements for collecting material are as follows:

For female representatives, discharge from the urethra is taken no earlier than an hour after the last act of urination. For collection, only a sterile cotton swab (“urethral”) is used, which is inserted into the lumen of the urethra (to a depth of 2-4 cm). After several rotational movements, the doctor should remove the tampon and place it in a special container for transportation.
In men, discharge is collected 2 hours after the last bladder emptying. The further algorithm for collecting material is similar to the previous one.

When the discharge is very small or absent altogether, therefore the biological substrate for research is obtained by scraping the anterior wall of the urethra.

Principles of treatment

It is based on etiological and pathogenetic orientation. This is necessary in order to completely destroy the pathogenic microorganism, and not just stop the symptoms of the disease.

Etiological therapy includes the administration of the following groups of drugs:

antibacterial agents (preference is given to penicillins and cephalosporins of the latest generation);
antiviral drugs;
antifungal agents.

If we're talking about about urethritis that has arisen against the background of metabolic disorders in the body, then to correct the condition it is necessary to combat oxalaturia, uraturia, etc.

Pathogenetic therapy involves the fight against anatomical defects (for example, strictures of the urethra) or other causes that contribute to the progression of the disease (inflammatory processes around the urethra and others).

In chronic form of urethritis, Special attention is given immunostimulating therapy, thanks to which one’s own protective properties the patient's body.

All patients are also advised to adhere to special diet. It is necessary to refuse or minimize as much as possible the consumption of extractive substances that can cause an exacerbation of the disease (spicy, salty and fried foods, garlic, seasonings, semi-finished products, etc.).

In case of chronic urethritis, it is mandatory to local treatment. Various antiseptics (Furacilin, Chlorhexidine and others) are injected into the lumen of the urethra. For elimination unpleasant symptoms for balanoposthitis (inflammation of the foreskin in men), use Levomekol ointment, which can significantly reduce itching and burning sensation.

Do not neglect the methods of physiotherapeutic treatment (UHF, electrophoresis with antibacterial agents, etc.), as well as homeopathy (the use of decoctions and infusions based on natural ingredients).

In combination therapy methods traditional medicine have proven their effectiveness, as they contribute speedy recovery sick

Conclusion

Urethritis is an extremely unpleasant disease, because it can worsen not only the patient’s physical well-being, but also his emotional state. Often, due to illness, libido decreases and family life collapses.

If urethritis has tormented you, you should not delay your visit to the doctor and try to treat the disease yourself, because this can only aggravate the process and lead to a number of serious complications.

What is urethritis? This is an inflammation that occurs in the urogenital canal. The disease is diagnosed more often in men and appears regardless of age. Pathology differs in types, symptoms, and has treatment features.

Anatomy of the urethra

The urethra is located in the male urethra (anatomy features are shown in the photo). It looks like a hollow tube 16-24 cm long. The urethra in men is divided into three parts:

Prostatic is in the prostate. The length of this section of the urethra is approximately 4 cm. Otherwise, the section is called the prostatic section.
Membranous (membranous) - 2 cm long. The section is located behind the prostate, the second border is at the base of the penis. This is the narrowest part of the urethra.
Spongy (spongy) is located inside the penis. This is the longest section. Unlike others, it is the most mobile, ending in a meatus (hole).

Inflammation of the urethra is more common in men. This is due to the characteristics anatomical structure. The causative agents of urethritis are usually those that enter the genitourinary system. Division into anterior and posterior inflammation typical only for the male half. The canal itself has two sections. Posterior urethritis occurs above the membranous part. The anterior one is located near the bladder.

Classification of the disease

When symptoms appear, treatment for urethritis in men is tailored to the etiology, intensity, and stage of the pathology.

Urethritis is divided into primary, which appears as a separate disease, and secondary, which develops against the background of other pathologies. The flow can be acute, subacute and torpid. Chronic disease occurs with varying intensity - high, moderate or low activity.

Nonspecific urethritis is caused by microorganisms that constantly live in the body, staphylococci. At the same time, the immune system is not able to cope with pathogens on its own. Specific is caused by gonorrhea, chlamydia, etc., appears in tuberculosis.

Desquamative urethritis develops against the background of chronic degenerative processes. This leads to a narrowing of the canal and the formation of pus inside. Interstitial inflammation of the urethra occurs due to hypothermia. This type of pathology is accompanied elevated temperature, is very difficult to tolerate.

Causes of the disease

The main causes of urethritis are pathogenic microflora and bacterial pathogens:

Gonorrheal is caused by the appearance of gonococci. Infection occurs mainly during sexual intercourse. By everyday means the infection is transmitted less frequently.
Trichomonas appears two weeks after infection with bacteria. In many men, the disease occurs in a latent form. If treated incorrectly, trichomonas appears.
Bacterial occurs due to pathogenic microflora. It may become more active against the background of weakening immune system, unprotected sex or using catheters.
Viral is caused by chlamydia. It provokes microflora dysbiosis.
the urethra appears rarely. The cause of the disease is a yeast fungus. It is activated after long-term use antibiotics, weakening of the body, inflammation.

Chronic urethritis develops against a background of weakened immunity and the spread of inflammation beyond the urinary tract. The acute form also enters this phase if the disease has not been completely cured. Other causes of urethritis:

kidney pathologies;
poor nutrition;
injuries;
sexual infections;
maceration;
hypothermia;
insufficient hygiene;
insertion of various medical instruments into the urinary canal, dilatation of the urethra;
violation of blood microcirculation in the pelvis;
allergic reactions.

Non-infectious urethritis can occur due to a violation metabolic processes, oncology. The disease appears after long rides on horseback, a bicycle or a motorcycle. The occurrence of nonspecific urethritis is caused by the proliferation of streptococci in the microflora, coli in the urethra.

Causes of bacterial urethritis:

defects genitourinary system(can be acquired or congenital);
intoxication of the body;
excessive drinking;
caries;
ureteral stenosis;
chronic inflammation;
allergy;
increased levels of uric (and other) acids;
excessive consumption of marinades, fatty and spicy (as well as too salty and sour) foods.

Inflammation can be triggered by cardiovascular diseases, emotional stress, and high physical activity.

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Symptoms of urethritis

Inflammation has a different incubation period. Initial symptoms Urethritis in men with gonorrhea appears after 3-7 days, chlamydia - 1-2 weeks, and trichomoniasis - 14-21 days. The viral form of the disease manifests itself after months, the tuberculous form - after years. The shortest incubation period for allergic form- just a few hours.

Symptoms of the disease vary in intensity. The main signs of urethritis:

swelling and irritation on the penis;
discharge of mucus from the urinary tract;
burning in the urethra;
in the morning, pus appears from the penis;
the appearance of yellowish crusts on the penis;
redness around the urethra;
itching and sharp pains during emptying of the bladder;
blood clots in semen and urine;
stomach pain in the lower part;
unpleasant odor from the urinary tract;
tingling in the penis;
pain during sex;
violation of ejaculation and erection;
the urethra sticks together;
cloudy urine;
blood appears from the urethra;
frequent urge to empty the bladder;
increased sensitivity of the penis;
bloody discharge;
change in urine pressure.

There may be sticking of the urethra and redness of the head of the penis. Abdominal pain appears periodically. The beginning and end of bladder emptying is always accompanied by sharp and severe pain. When the disease becomes chronic, there remains a slight itching in the urethra without discharge, and discomfort is felt. All other symptoms disappear. Types of urethritis differ in their symptoms.

Most common symptoms

Gonococcal (gonorrheal)	Sharp and severe pain during stool, cloudy urine with gray-yellow pus from the urethra. Blood clots are visible in semen and urine.
Ureaplasma urethritis	It occurs together with trichomoniasis and gonorrheal urethritis. White-green mucus appears from the penis. Burning, pain and itching are felt in the urethra, symptoms worsen after drinking alcoholic beverages.
Tuberculous	Temperature rises, severe sweating, fatigue.
Mycoplasma	It occurs along with trichomonas and gonorrhea and has symptoms corresponding to them.
Chlamydial	Burning in the urinary tract, small discharge. More often it is completely asymptomatic.
Mycotic	Liquid discharge from the urethra, white or pinkish. The mucous membrane is covered with a cheesy coating.
Gardnerella	It does not have any distinctive features. The symptoms are the same, depending on what form of urethritis it is mixed with.
Trichomonas	The head of the penis is constantly itching, emptying is difficult, and gray discharge appears.
Viral	General symptoms, weak. Conjunctivitis appears, joints hurt, and discomfort is felt in the urethra.
Bacterial	With vague general symptoms. Pus appears from the urethra with unpleasant smell turns yellow as it dries.

Congestive urethritis is accompanied by dysfunction of the reproductive system. General symptoms rarely appear. Signs depend on the nature of the damage. Most often, burning and pain occur during bowel movements. Features of the allergic type of disease include swelling. Additionally, itching appears.

Diagnosis of the disease

A urologist treats urethritis in men. Before drawing up a treatment regimen, the type of disease and cause are clarified. If infection occurs, consultation with a dermatovenerologist is necessary. Before making a diagnosis, a general smear is taken from the urethra. The scrotum and penis are palpated and visually examined. Diagnostics includes tests:

urine;
analysis according to Nechiporenko;
blood;
bacterial culture of urine;
3 glass sample.

Urethroscopy, PCR, ELISA are performed. An ultrasound of the urethra is prescribed. The presence of a bacterial species may be indicated by an increased level of white blood cells and the presence of protein in the urine.

Treatment

Depending on the cause of the disease, a specific therapeutic regimen is prescribed. IN complex treatment anti-inflammatory drugs for the genitourinary system are included (Ibuprofen, Nemesil, Indomethacin). Antibiotics for urethritis are indicated for all etiologies.

Drugs are divided into groups:

macrolides (Erythromycin, Azithromycin, Clarithromycin);
tetracycline drugs (Doxycycline, Tetracycline);
fluoroquinolones (Pefloxacin, Ofloxacin, Levofloxacin, Abactal);
celofasporins (Cefazolin, Ceftriaxone).

Uroantiseptics (Monural), sulfonamides (Trimezol, Tsiplin and others) can be prescribed. Canephron relieves swelling and inflammation in urethritis.

Treatment may last several weeks. It depends on the type and extent of the disease. Hospitalization is not required, treatment is carried out at home. If therapy is not followed, the disease becomes chronic.

During the treatment period, sexual intercourse is excluded and a diet is observed. Fatty, spicy and highly salty foods are excluded from the diet. You cannot eat smoked meats or marinades. Alcohol is completely excluded. You need to drink as much fluid as possible every day.

Attention! Before treating urethritis with antibiotics, a test is done to determine the sensitivity of the pathogens to them.

Drugs to which microorganisms react are selected. For gonorrhea and bacterial urethritis, drugs of the cephalosporin group are used or:

Kanamycin;
Erythromycin;
Olethetrin;
Monural;
Tetracycline.

Bicillin 3 and 5 are shown in small courses. If the gonorrheal form of inflammation is complicated by additional infections, several antibiotics are prescribed simultaneously. Most often - Gentamicin and Azithromycin. The treatment regimen also includes those that strengthen the immune system.

Chlamydial urethritis is determined using PCR diagnostics. The courses are assigned:

Doskicycline;
Levofloxacin;
Erythromycin;
Josamycin;
Ofloxacin.

Azithromycin is indicated only for a single dose, but course use of Josamycin is more effective. The same tablets for urethritis are also used to treat mycoplasma species, if there is sensitivity to the drugs. If strains are resistant, Moxifloxacin is used. If the virus is insensitive to it, the drug is replaced with Unidox Solutab.

Trichomonas urethritis is treated immediately with a large amount of Metronidazole once or with a weekly course with a reduced dosage. Tinidazole is suitable for therapy, but in a single use.

Ureaplasmic urethritis is most often caused by ureaplasma. To cure the disease, antibiotics of the tetracycline group or Josamycin are prescribed. Famciclovir, Acyclovir or Valaciclovir are used to treat the viral form of urethritis.

For acute urethritis, antibacterial agents are prescribed in tablets. They can be used as injections and are inserted into the urethra using a catheter. There are different treatment regimens - monotherapy or the use of several drugs at once.

For candidal urethritis, antifungal agents Nystatin, Clotrimazole, Fluconazole or Pimafucin are prescribed. At allergic form diseases apply antihistamines. To treat a traumatic form of pathology, surgery may be indicated.

Chronic nonspecific urethritis is difficult to treat. The disease is almost always accompanied by other pathologies. As a result, the symptoms of urethritis are blurred or absent. Initially, the patient is prescribed immunostimulating medications for urethritis, and later antibiotics are added.

In case of desquamative form of pathology, it is indicated surgery. For the treatment of urethritis, ointments Fitolysin, Levomekol, Dioxidin are prescribed. Tetracycline is used to treat the herpetic form of the disease.

Complex therapy includes physiotherapy. Instillation of the urethra with the use of Hydrocortisone, Dioxidin, Miramistin is prescribed. The drugs are administered directly into the canal using injections. Urethral lavage is permitted only when chronic disease. Additionally, UHF, magnetic and laser therapy, and electrophoresis are prescribed.

Treatment with folk remedies

Treatment of urethritis at home using only traditional methods will not give any effect. A foundation is needed - drug therapy. Urethritis is an inflammation urinary canal. To eliminate it, infusions are made from herbs - celandine, St. John's wort, knotweed, bearberry, coriander and others. A decoction of currant leaves is useful. Cornflower flowers, grated, are brewed fresh root wheatgrass.

To relieve swelling and redness of the penis, the organ is washed with chamomile infusion or compresses are made from calendula. Herbs are antiseptic and help eliminate itching and burning in the head of the penis. Oak bark compresses are used for the same purposes.

In the acute form of urethritis, the symptoms are pronounced; hirudotherapy is used to eliminate them. Leeches are applied to the lower back. To normalize urination, eight procedures are enough.

Treatment folk remedies offers a separate treatment regimen for primary urethritis and its initial stage. The head of the penis is wiped with your own urine on the first day, and with a weak solution of potassium permanganate on the second.

Washing is done after each bowel movement. On the third day, the penis descends into hot water at four hour intervals. On the 4th day, a man should take a steam bath in a dry sauna or steam bath.

This treatment regimen helps eliminate inflammation within a week. The penis can be washed with bergamot oil mixed with vodka and water. This prevents the spread of infection.

Attention! All traditional methods are only auxiliary. The main treatment is medication.

Complications of urethritis

Urethral diseases, incorrect treatment or its absence can lead to Reiter's syndrome. With frequent inflammation of the urethra, a narrowing of the urethra occurs. This can trigger the appearance of a stricture. With advanced urethritis, more severe complications appear. Most often, the pathology leads to prostatitis, male infertility, veseculitis, orchitis. Urethral cancer may develop.

Prevention

In most cases, urethritis is caused by various bacteria and is transmitted during sexual intercourse. As a preventive measure, it is necessary to maintain personal hygiene, be selective in intimate relationships, and use condoms. Proper nutrition is important.

It is necessary to exclude salty, spicy and fatty foods, and alcoholic drinks. When you have the urge to go to the toilet, you should empty your bladder immediately. Check with a urologist annually to avoid hypothermia.

Urethritis – serious illness, which can lead to serious complications, including infertility and cancer. Self-medication is not allowed, as it is necessary to know the cause of the disease and the type of pathogen. Uncontrolled use of antibiotics can lead to worsening of the condition.

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Urethritis is an insidious disease in which inflammation of the urethra occurs. The disease manifests itself in different ways, depending on the type of disorder. The disease is often transmitted to a partner through sexual contact. It can be difficult to cure urethritis, since the disease is aggravated by parallel problems. This fact delays healing and causes complications.

Urethritis is an inflammatory disease of the genitourinary system that can be infected through intimate contact.

What is the essence of urethritis?

The sooner you seek help, the less advanced the inflammatory process will be.

The urethra is the outermost opening in the bladder. This is a thin hollow tube measuring 4-25 cm. Due to inflammation of the urethra, problems with urination occur. Urethritis is often confused with similar diseases urinary organs, for example, cystitis. The disease is not dangerous if timely treatment, but purulent urethritis is life-threatening.

Main reasons

The condition is caused by gonococci, trichomonas, chlamydia and mycoplasma, herpes virus and enterococcus fecalis. main reason lies in infectious diseases. An inflammatory process develops in the urethra. TO non-infectious factors relate:

mechanical damage to the mucous membranes of the genitourinary system;
allergies;
tumors;
diseases of the pelvic organs and bladder - colpitis, cystitis;
defloration;
radiation therapy;
violation of hygiene standards;
prolonged exposure to the cold;
drinking alcohol and soda;
use of untreated medical instruments.

How to recognize the symptoms?

Urethritis is manifested by frequent, painful, enuresis with impurities, temperature fluctuations.

Pain from urethritis occurs in all types. The most common signs of urethritis are:

frequent urination with pain;
burning;
inflammation of the urinary canal;
temperature;
the urethra produces a strong discharge;
urine smells unpleasant;
clear urine;
there may be purulent threads in the urine.

There are also symptoms of urethritis characteristic of the male sex:

blood impurities in urine or semen;
sensitivity of the penis increases;
pain during sexual intercourse.

Chronic inflammation is characterized by intermittent symptoms, almost no itching and burning. In parallel, there is a development with frequent painful urge. Sometimes urinary incontinence occurs. The allergic type is accompanied by nasal congestion, skin rash, tearfulness and shortness of breath. Upon examination, the urologist will point out signs of the disease: swelling and inflammation of the mucous membrane of the urethra. Pain with the allergic and secondary bacterial type is almost absent. A person experiences painful sensations in the morning. In females, no symptoms may be observed, but the external opening of the urethra is glued together.

Inflammation in men is caused by the same reasons as in women.

The specific type manifests itself mainly at the end of sexual intercourse. If a person is infected, he may not know anything about the problem. In such a situation, the disease manifests itself at any time. The appearance of non-specific type. If the urinary canal becomes inflamed against the background of reduced immunity, the disease is inevitable. A person may develop urethritis or another problem, for example, thrush. It all depends on defense mechanisms.

Classification

Inflammation of the urethra can be infectious or non-infectious in nature.

Based on the type of urethritis, researchers of the problem systematize the disease into different types. Based on etiology, 2 groups with subtypes are recognized:

Infectious urethritis:
- herpes;
- mycotic;
- mixed.
Non-infectious urethritis:
- Ray. Develops against the background of radiation treatment.
- Allergic. It appears when the body is affected by an allergen.
- Traumatic or mechanical. Worries about rupture or tear of the urinary canal and medical manipulation.
- Congestive urethritis. Causes stagnation of the pelvis.

There is a classification based on the course of the disease. An unstarted type is divided into the following groups:

spicy;
subacute;
torpid.

Viral type

This species is associated with viruses, especially perigenital chlamydia. The disease provokes an inflammatory process of the genital organ. Indeed, with viral urethritis, bacteria enter the epithelial cells of the urinary canal. There they multiply intensively. If the disease has passed, then immunity to the disease is formed for the future. pathogenic microorganisms.

Bacterial

Bacterial urethritis develops due to lack of hygiene and/or pathogens entering the urethra.

Appears through the entry of bacteria into the urethra. Pathogenic microflora displaces opportunistic and non-pathogenic ones. The main way of development and transmission is intimate contact with the carrier. But it also occurs with prolonged catheterization of the bladder and transurethral endoscopic manipulation. The disease develops in primary and secondary forms. The first goes into if treatment is not carried out on time. The secondary type is provoked by a previous infection. Discharge and pain are worse in the morning.

The primary form of bacterial urethritis is characterized by:

pain during sexual intercourse and urination;
burning and itching inside the urethra;
the urethra secretes purulent masses.

The secondary form appears:

pain when urinating;
purulent discharge.

Trichomonas type

In 8 out of 10 cases of this type of disease, the carriers are men. In this case, a chronic or infectious lesion is predominantly noted.

Symptoms of the disease manifest themselves after some time - from 5 days to 2 weeks. With trichomonas urethritis, the patient notices a previous discharge from the urinary canal similar to foam. The genitals itch. If the disease develops in males, then the symptoms may not be expressed. Transmission of Trichomonas urethritis occurs exclusively through sexual contact with a carrier of the infection.

Candidamycotic type

The candidiasis type of urethritis is caused by microscopic fungi.

The disease is formed as a result of infection of the urethra by a yeast fungus. If the urethra becomes inflamed after an antibiotic, it is canceled. It is characterized by slight itching, as well as burning, whitish discharge or its absence. Candidiasis urethritis is associated with complications after antibacterial therapy, antibiotic use, and female vulvovaginitis. The classification of urethritis assigns one of the leading positions to this type.

Gonorrheal type

The cause of the disease is gonococcal infections. Gonorrheal urethritis is transmitted through sexual intercourse when one of the partners is a carrier. There are other ways in which you can become infected. Ureaplasma urethritis sometimes accompanies the gonorrheal form. Desquamative gonorrheal urethritis progresses during the degenerative process. Not excluded reinfection, because the disease does not form lasting immunity.

Diagnostics: where to start?

The problem is addressed to a therapist. The tactics for examining doctors are similar. A physical examination is performed 3 hours after the last urination. The doctor will take a medical history and look at the urethra. If it is red, swollen, and there is discharge (especially mixed with pus), the doctor makes a preliminary diagnosis. When analyzed it will show a cloudy consistency. The substance is sent for laboratory diagnostics. Only when a person passes a chemical analysis does a specialist give a conclusion with accurate diagnosis. Against the background of the appearance of urethritis, polymerase chain reaction indicators change. The procedure allows you to determine the type of pathogen. Diagnosis of the disease is supplemented by ultrasound examination. A woman, in order to avoid the inflammatory process of the pelvic organs, as the root cause of urethritis, is advised to visit a gynecologist.

Every second patient infectious urethritis has an illness of unknown etiology.

Effective treatment

What medications should I take?

Medicines for urethritis are prescribed depending on the type of illness, which can be determined by taking tests at the hospital.

Treatment of urethritis of the gonorrheal type is carried out by a venereologist from the dermatovenerological clinic. The non-gonorrheal type is examined by a local physician. The therapy that will be given to the patient depends on the nature, course and neglect of the disease. Treatment must be taken based on the type. Basic medications are presented in the table.

The most common patients of a urologist are men who seek treatment for urethritis. The disease manifests itself at any age and passes with severe symptoms. Severe itching and pain when urinating do not allow a man to wait out a relapse without going to the doctor. If acute form If the disease is not treated, the inflammatory process will spread to the prostate gland and testicles, which will bring with it even more painful processes.

What is urethritis in men?

And it happens differently for men. If the disease in the female body is practically asymptomatic due to anatomical feature urinary tract, then men suffer from this disease more. Male urethritis is an inflammation of the urethra caused by various reasons. The most common among them is any venereal disease, promoting inflammation.

After pathogenic microbes enter the urethra, a increased fatigue, weakness, preceding the main symptoms of urethritis. Urethritis also has a non-infectious origin, but rarely. Factors in such cases include allergic reactions, trauma to the genitals, metabolic disorders or poor nutrition.

Urethritis in men can negatively affect reproductive function and lead to serious disruption of the functionality of the genitourinary system. Therefore, identifying signs that indicate the onset of an inflammatory process in the urethra is an indicator of consulting a doctor for examination and comprehensive treatment.

Symptoms and signs of urethral inflammation

The first symptoms of urethritis in a man appear, depending on incubation period pathogen, from several hours (allergic) to several years (tuberculosis). The most typical of all types of urethritis are the following symptoms:

Burning, itching, pain when urinating.
Purulent discharge.
Frequent urination.

Hyperemia or high temperature with urethritis, as a rule, it is not observed. The discharge depends on the pathogen and is different character. Often this is a green or white with an unpleasant odor, which appear in the morning and form yellow crusts on the penis. With inflammation of the urethra, redness and sticking of the external opening, pain in the lower abdomen, and cloudy urine may be observed.

Causes

Urethritis in a man can be caused by several reasons. As already mentioned, the most common are sexually transmitted diseases. But inflammation of the urethra can occur if a man ignores the rules of personal hygiene, because dirt quickly collects on the genitals and pathogenic bacteria multiply.

E. coli, which is on the surface intimate area remains after bowel movements, very actively increases its population on the skin. When it gets deep into the urethra, signs of urethritis develop immediately. Pathogenic microbes that affect the urethra include:

staphylococci;
streptococci;
coli.

Urolithiasis can also cause the development of urethritis. Stones that are located in the kidneys, under certain conditions, can end up in a man’s urethra, causing inflammation. Medical interventions also often cause inflammation, since microscopic abrasions very quickly become infected with an infection in the body and then become inflamed.

Diagnostics - what tests to take?

The presence of any of the above symptoms is a reason to visit a urologist, who should make a diagnosis based on laboratory and clinical test data. During the initial examination, the doctor examines the discharge from the urethra by applying pressure, examines the swelling and redness of the urethral sponges, feels how painful and dense the urethra is and whether the inguinal lymph nodes are enlarged.

Each patient with suspected urethritis is examined for HIV infection and syphilis, and is also sent for the following tests:

Urogenital smear.
Culture from the urethra for sensitivity to antibiotics.
PCR studies to identify pathogens of urethritis.
General urine analysis.
Three-glass urine sample.
Urethroscopy.
General blood analysis.
Biochemistry of blood.
Rheumatic tests if urethritis appears after a sore throat.

How to treat urethritis in men - drugs

Before starting treatment, the doctor warns that sexual intercourse is completely prohibited during treatment for urethritis, oral sex, masturbation. If the disease is caused by a sexually transmitted infection, then treatment of the sexual partner is mandatory. The diet should also be followed, excluding spicy, salty, pickled, fried, spicy foods. Drinking alcohol is strictly forbidden, and drinking water should be consumed at least 2 liters daily to improve metabolism and speedy recovery.

Antibiotics

It is impossible to cure urethritis without antibiotics. The type of medication, dosage and treatment regimen for urethritis is determined by the doctor, depending on the causative agent of the disease and based on the type of pathology. Common antibiotics It is not prescribed for urethritis, since each microorganism has its own sensitivity to drugs.

For the treatment of gonococcal urethritis, antibiotics such as Azithromycin and Cefipmaxone are prescribed.
For the treatment of Trichomonas urethritis, Trinidazole and Metronidazole are more suitable.

Antiseptics

Effective antiseptic drugs include: Miramistin, Furacilin.

Ointments and suppositories

In the complex of antibacterial therapy, local drugs (ointments and suppositories) are used to speed up the healing process. For example, it will be effective in the treatment of viral urethritis caused by herpes. Rectal suppositories in terms of their effectiveness, they are equal to injections, so urologists often prescribe them for the treatment of various types of urethritis in men: Metronidazole, Hexicon, Indomethacin, Cifran.

Immunomodulators

These are substances that affect the functioning of the human immune system. It is known that the higher the immunity, the faster the recovery will come. Immunomodulators are mandatory medications for the treatment of urethritis in men. They are prescribed in addition to antibiotics so that they do not suppress the immune system.

Effective drugs domestic production: “Timalin, “Myelopid.”

Vitamins

During the treatment of urethritis, vitamin deficiency in the body must be replenished, so doctors prescribe complex therapy multivitamin complexes with vitamins A, E,

C, D and minerals. The right diet nutrition can compensate for the lack of some vitamins, but not fully. For example, vitamin A is contained in the form of esters in products of animal origin, so with a strict diet, its reserves cannot be replenished at the required levels.

Popular vitamin complexes for urethritis: “Bio-max”, “Pikovit forte”.

Treatment of urethritis with folk remedies

Cure urethritis alone folk ways impossible. But decoctions and herbal tinctures will help alleviate the condition. We offer several folk recipes which will help with chronic urethritis and will be an excellent prevention of relapses:

Infusion of black currant leaves. Great replacement vitamin complex and an antiseptic. Take 30 gr. dry leaves, pour a glass of boiling water, leave for one hour, then strain. Drink three times a day before meals (15 minutes before). If possible, use fresh berries black currants for food. The duration of treatment is not limited.
Oak bark infusion. It will help relieve burning and pain when urinating. Brew a tablespoon of oak bark with boiling water (1 cup), leave for three hours. The resulting product should be drunk 1 tbsp. l. 3 times/day before meals, warm. The infusion is also used for men in the form of baths or lotions.
Infusion of cornflower flowers. Pour boiling water over one teaspoon of dried cornflower flowers, leave for an hour, then consume 2 tbsp. l. before meals 3 times a day until the natural microflora is restored and the inflammatory process passes.

Complications

Treatment of urethritis in men is mandatory, because ignoring the inflammatory process can lead to damage not only to the urethra, but also to the scrotum, testicles, and prostate gland. Urethritis is difficult to treat, but diseases of the reproductive system can lead to inability to bear children, and such processes are often irreversible.

In men, complications of urethritis can lead to : prostatitis, funiculitis, seminal vesicles, the formation of epidyrmitis or orchitis.

Chronic desquamative urethritis can lead to keratinization of the epithelium, and staphylococcal pathology can lead to a more complex consequence of urethritis - narrowing of the urethra, which occurs due to scarring of the mucosal tissue. This disease leads to disruption of the outflow of urine, its return to the kidneys with the formation renal failure and pyelonephritis.

Types of male urethritis

Male urethritis is divided into several types and types. It can be infectious and non-infectious, primary and secondary, that is, it enters the urethra from already infected organs. Classification of urethritis in men is also carried out according to its characteristics (types of pathogen).

Urethritis is the process of inflammation of the urethra, the thin duct through which urine is removed from the bladder. Often caused by a bacterial infection, urethritis can cause different symptoms in men and women. Infectious agents (including carriers of chlamydia, gonorrhea and herpes) are transmitted through sexual contact and can cause urethritis in both men and women, although the woman may not experience any symptoms. If symptoms do occur, urethritis may be difficult to distinguish from a bladder infection; however, the treatment for both diseases is similar. Urethritis can also be caused by sexually transmitted diseases; Such infectious diseases are most common among women.

Causes

In women, urethritis often occurs as a result of an infection caused by bacteria that normally inhabit the anal area and have no effect. diseases. If these bacteria enter the urinary tract, urethritis may develop.
Urethritis can occur through sexual transmission of the herpes virus or bacteria that cause chlamydia or gonorrhea.
Long-term use of a urinary catheter increases the risk of urethritis.
Sexual activity can damage the urethra in women and promote inflammation.
Certain soaps, bath oils, and vaginal douches can irritate the urethra.

Symptoms

Burning when urinating.
Frequent urination with small amounts of urine coming out.
Insistent need to urinate.
Blood in urine.
Yellowish discharge from the urethra.
Pain in the lower abdomen.
Painful sexual intercourse in women.

Diagnostics

Medical history and physical examination.
Analysis under a microscope and culture of discharge from the urethra and urine.

General clinical examination of urethral discharge

Discharge from the urethra is examined mainly for the diagnosis of the inflammatory process in non-gonococcal urethritis, gonorrhea, trichomoniasis, chlamydia, syphilis, etc. In addition, the study allows us to differentiate a number of pathological and physiological conditions characterized by discharge from the urethra (prostatorrhea, spermatorrhea, urethrorrhea).

When examining discharge from the urethra, the quantity and composition of cellular elements depend mainly on the severity and duration of the inflammatory process. According to the European Urethritis Guidelines (2001), the diagnosis of urethritis should be confirmed by the detection of polynuclear neutrophils in the anterior urethra, since discharge in men does not always indicate pathology. Smears from the urethra and/or the first portion of urine serve as informative material for the study. Conducting two types of studies allows us to identify cases that might be missed if only one of them is used. The inflammatory condition of the mucous membrane of the urethra (urethritis) is expressed by the presence of at least 5 polynuclear neutrophils in the field of view under immersion magnification of the microscope. The depth of the pathological process in the urethra is evidenced by the predominance of cylindrical and parabasal epithelial cells in the imprint smears. During the initial review of drugs, the following practical conclusions can be drawn.

Leukocytes (neutrophils and lymphocytes) predominate - acute urethritis or exacerbation of chronic urethritis; with a high content of eosinophils (over 5-10%) - allergic urethritis.
Epithelial cells predominate with a small number of leukocytes - chronic urethritis with epithelial metaplasia (desquamative urethritis) or urethral leukoplakia.
A significant number of red blood cells along with leukocytes and epithelial cells - traumatic urethritis, urethral tumor, crystalluria, ulceration of the mucous membrane, etc.
There are no leukocytes or only a few in the field of view at high magnification of the microscope - prostatorrhea (lipid grains are present); spermatorrhea (many sperm); urethrorrhea (mucus predominates without shaped elements- secretion of the urethral glands).
With a small content of polynuclear neutrophils, massive accumulations of small pleomorphic rods on epithelial cells (key cells) - urethritis caused by Corynebacterium vaginale.
Key cells are present, a large number of various bacteria are present, polynuclear neutrophils are single, there is no phagocytic reaction - bacterorrhea.

With a more detailed examination of smears, the criteria for diagnosing urethritis according to the European Guidelines for Urethritis (2001) are as follows.

A Gram-stained smear from the urethra containing at least 5 polynuclear neutrophils per field of view at high magnification (x1000) of the microscope (the average of 5 or more fields with the highest concentration of polynuclear neutrophils), and/or:
detection of at least 10 polynuclear neutrophils per field of view at high magnification (x1000) of the microscope (the average of 5 or more fields with the highest concentration of polynuclear neutrophils) in a Gram-stained preparation from a sample of the first portion of urine.

The sensitivity of the above tests depends on how long the patient has not urinated before taking the material for testing. A period of 4 hours is usually recommended.

When identifying an inflammatory process in the urethra, it is necessary to establish its etiology. Urethritis can be either gonococcal (if Neisseria gonorrhoeae is detected) or non-gonococcal (gonococci are not detected). A significant portion of non-gonococcal urethritis is caused by chlamydia. Cases in which neither chlamydia nor gonococci can be detected are classified as non-gonococcal non-chlamydial urethritis (nonspecific urethritis).

To test for gonococci, discharge from the urethra, prostate gland, urine in men and discharge from the vagina, cervix, paraurethral ducts, and rectal lavage in women are simultaneously taken. For diagnosis, a bacterioscopic method is used (Gram staining of a smear), which for acute gonorrhea in men has high sensitivity and specificity (95 and 98%, respectively). In chronic and treated cases of the disease in men, a positive result is observed only in 8-20% of cases. In men, in acute cases the urethra is affected, in chronic cases - the prostate gland, seminal vesicles; in women, the Bartholin glands, vagina and urethra are primarily affected, later - the mucous membrane of the cervix, fallopian tubes, rectum, in girls - the vagina, urethra, rectum, conjunctiva of the eyes. One-time negative result not proven, so repeated studies are necessary.

When examining smears from patients with gonorrhea, a bacterioscopic picture of three types is mainly observed:

leukocytes cover the entire field of view, gonococci are often located intracellularly, some of them are localized extracellularly; other microorganisms are absent;
the cellular picture is the same, but gonococci and foreign microflora are absent (this picture is typical for chronic gonorrhea);
a small number of degenerated leukocytes and abundant foreign microflora, the appearance of which indicates an improvement in the course of the process (with treatment).

Trichomoniasis is widespread among women aged 2-40 years, it is less common in men and extremely rare in children. The causative agent of the disease is Trichomonas vaginalis. The disease in women is characterized by liquid, foamy or purulent discharge, irritation of the vaginal mucosa. In most men, the disease proceeds unnoticed; in some cases, the so-called “morning discharge” (discharge of a drop of pus from the urethra) is noted, and only in a small proportion the infection takes an acute form with symptoms of urethritis and prostatitis. In women, Trichomonas are found mainly in the vulva and vagina, less often in the urethra and cervix. In men, the urethra, prostate, and seminal vesicles are affected.

Chlamydia. Chlamydia is rarely diagnosed using bacterioscopic methods; serological methods or PCR are predominantly used.

Candidiasis. Candida is the most common pathogen mycotic urethritis, sexually transmitted. Much less often, candidal urethritis develops as a consequence of dysbiosis after treatment with antibiotics. Smears from the urethra reveal mycelium and spores, which confirms the diagnosis.

Treatment

Antibiotics are prescribed to combat bacterial infections; they must be taken for the entire prescribed period; stopping treatment too early may result in a more serious and more difficult to treat infection. With sexually transmitted diseases, only one partner may have symptoms, but the other partner may also be infected.
Therefore, both partners must undergo treatment to prevent a never-ending cycle of infection.
Analgesics can be used to reduce pain.
Cranberry juice may increase the acidity of urine and make some medications more effective. infectious diseases urinary tract.
Contact your doctor if you or your partner experience painful, frequent urination, or if you notice abnormal discharge from the vagina or penis.

Prevention

Using condoms during sexual intercourse helps reduce the risk of infection.
Recommended good hygiene, especially before sexual intercourse. Unscented soap should be used. Showers are less likely to promote urethritis than baths.
To flush bacteria from the vagina, women should drink some water before sexual intercourse and urinate 15 minutes after; If necessary, they should use a water-soluble lubricant (not Vaseline) to reduce the risk of bruising during sexual intercourse.
After using the bathroom, women should dry themselves from front to back to avoid introducing fecal bacteria into the urethra.
Women should not use vaginal lavage unless recommended by a doctor.
People who suffer from recurring urethritis should drink at least eight glasses of fluid per day and should avoid caffeine and alcohol, which can irritate the bladder.