Urethritis, or urethral inflammation, is often caused by infection. Characteristically, patients complain of urethral discharge and dysuria. On examination the discharge may be purulent or mucopurulent. Asymptomatic infections are common (McCormack and Rein, 1990; Krieger, 1996; Centers for Disease Control and Prevention, 1998). The most important pathogens are bacteria, Neisseria gonorrhoeae, and Chlamydia trachomatis.
Testing is recommended to document a specific disease because both of these infections are reportable to health departments, and because specific diagnosis may improve compliance and partner notification (Centers for Disease Control and Prevention, 1998; Centers for Disease Control and Prevention, 2006). The traditional diagnostic algorithm includes microscopic examination of the Gramstained urethral smear for gram-negative intracellular diplococci and culture for N. gonorrhoeae. New nucleic acid amplification tests have proved accurate for detection of N. gonorrhoeae and C. trachomatis in first-void urine in high-risk populations (Mahony et al, 2001). If diagnostic testing is unavailable, patients should be treated empirically for both infections (Centers for Disease Control and Prevention, 1998; Centers for Disease Control and Prevention, 2006).
Complications of urethritis in men include epididymitis (see below), disseminated gonococcal infection, and Reiter’s syndrome (McCormack and Rein, 1990; Krieger, 1996; Mead, 1990). Complications of urethritis in female sexual partners include pelvic inflammatory disease, ectopic pregnancy, and infertility (Centers for Disease Control and Prevention, 1998; Rein, 1996). Complications in children include neonatal pneumonia and ophthalmia neonatorum (Centers for Disease Control and Prevention, 1998; Centers for Disease Control and Prevention, 2006).
Gonorrhea is diagnosed when N. gonorrhoeae is detected by Gram stain, culture, or nucleic acid amplification testing. Nongonococcal urethritis (NGU) is diagnosed when gram-negative intracellular organisms cannot be diagnosed on microscopic examination. C. trachomatis, the most common infectious cause of NGU, is responsible for 23-55% of cases in reported series, but the proportion of cases is substantially lower in urological practice. The prevalence of chlamydial infection differs by age group, with a lower prevalence among older men. In addition, the proportion of NGU caused by C. trachomatis has been declining.
Documentation of chlamydial NGU is important because this diagnosis supports partner referral, evaluation, and treatment (Centers for Disease Control and Prevention, 1998).
The etiology of most cases of nonchlamydial NGU is unknown. The genital mycoplasmas, Ureaplasma urealyticum and perhaps Mycoplasma genitalium or M. hominis, are implicated in 20-30% of cases in some series (Krieger, 1996; Horner et al, 2001; Totten et al, 2001; Stamm et al, 2007). Specific diagnostic tests for these organisms are not indicated routinely. Trichomonas vaginalis, a protozoan parasite, and herpes simplex virus (HSV) may also cause NGU (Joyner et al, 2000; Madeb et al, 2000). Testing and treatment for these organisms should be considered in situations where NGU is unresponsive to treatment (McCormack and Rein, 1990; Centers for Disease Control and Prevention, 1998; Centers for Disease Control and Prevention, 2006).
B. DOCUMENT URETHRITIS
It is important to document the presence of urethritis because some patients have symptoms in the absence of inflammation. Urethritis may be documented by the presence of any of the following clinical signs: mucopurulent urethral discharge on physical examination, =5 leukocytes per oil immersion microscopic field of the Gram-stained urethral secretions, a positive leukocyte esterase test on first void-urine, or =10 leukocytes per high-power microscopic field of the first-void urine (Krieger, 1996; Centers for Disease Control and Prevention, 2006). The Gram stain is the preferred diagnostic test for documenting urethritis and for evaluating presence or absence of gonococcal infection because it is rapid, highly sensitive, and specific.
AMOXICILLIN is one of the most commonly used antibiotics in the world. It belongs to the spectrum of β-lactam antibiotics, and is the drug of choice when it comes to treating bacterial infections, as it is well absorbed even when given orally. Hence, it is used to treat a variety of infections, including infections of the ear, nose throat, skin infections, urinary tract infections, lower respiratory tract infections, gonorrhea and other sexually transmitted infections etc. AMOXICILLIN for sinus infection treatment is also a very well-known use of this drug. Thus, its multipurpose use makes this drug a very popular one among medical practitioners. However, amoxicillin side effects are something that doctors need to be well aware of, so as to prevent them from occurring, as they can be life-threatening at times.
One of the most serious and dangerous of all side effects is anaphylactic reaction. An anaphylactic reaction is defined as a life-threatening type 1 hypersensitivity reaction to a drug which is given internally or orally. Around 1500 patients die yearly due to an anaphylactic reaction in the United States. However, this serious allergic response of the body only occurs in those patients that have a true allergy to penicillin and its derivatives, as opposed to people who present with pseudo-anaphylaxis or an anaphylactoid reaction. An anaphylactic reaction is characterized by the following signs and symptoms:
– Normally, a true anaphylactic reaction with systemic signs and symptoms begin showing within 72 hours of exposure to the allergen, without the need of further exposure. Skin involvement is one of the first signs seen. This includes generalized hives, skin rashes, itchiness, flushing. Fever is often experienced by people, along with the skin rashes.
– Swelling of lips, tongue and/or throat is also seen, as this is the body’s way of responding and fighting the inflammation.
– Respiratory distress, in the form of difficulty in breathing, shortness of breath, wheezing etc. may also be seen.
– Some patients may also complain of gastrointestinal problems like severe abdominal cramps, stomach pain, diarrhea etc.
– Other serious effects that may occur if immediate action is not taken to deal with the symptoms includes coronary artery spasms, which may lead to myocardial infarction. Consequently, there may also be a sudden drop in blood pressure, which may lead to lightheadedness and fatigue, along with loss of consciousness.
If none of the criteria for urethritis are met, then treatment should be deferred. The patient should be tested for both N. gonorrhoeae and C. trachomatis and followed up closely in the event of a positive test result.
Empiric treatment of symptoms without documenting the presence of urethritis is recommended only if the patient is at high risk for infection and is unlikely to return for follow-up. Empiric treatment should be appropriate for both gonococcal and chlamydial infection. Sex partners should be referred for appropriate evaluation and treatment.