Uretrit - an inflammation of walls of an urethra (urethra). Pains, gripes and burning are signs at an urination, pathological allocations from an urethra which nature depends on the causative agent of a disease. In the complicated cases inflammatory process passes also the next bodies of a small pelvis: prostate, bladder and bodies of a scrotum. Other consequence of an uretrit is narrowing (striktura) of an urethra or its full soldering. An important point in diagnostics of an uretrit is definition of its etiology. The bacteriological research of urine and dab from an urethra is for this purpose conducted. Treatment of an uretrit is carried out according to its reason (antibiotics, metronidazole, protivomikotichesky medicines), at development of adhesive process is shown buzhirovany urethras.
Uretrit – an urethra wall inflammation. Usually has the infectious nature. Extremely seldom develops without presence of the infectious agent (beam, toxic, allergic uretrit). Sometimes the trauma when holding a diagnostic or medical procedure (a bladder kateterization at men, introduction of medicines, etc.) becomes the cause of a disease.
Infectious uretrita are subdivided into two big groups: specific and nonspecific. Specific inflammatory process in an urethra is caused by causative agents of diseases, sexually transmitted (, a trichomonad, a hlamidiya, an ureaplasma, a mycoplasma). Opportunistic flora (staphylococcus, a streptococcus, fungi, proteas, colibacillus) becomes the reason of development of a nonspecific inflammation of an urethra.
Allocate primary and secondary uretrit. At primary inflammation of an urethra the infection gets directly into an urethra, most often – at sexual contact with the partner which has a disease, sexually transmitted. Secondary uretrit arises at spread of an infection from the inflammatory center located in other body (from pelvic bodies, seed bubbles, a bladder, prostate gland).
Conditionally pathogenic flora is the reason of development of a nonspecific inflammation of an urethra. Microorganisms get into an urethra at a long kateterization of a bladder at women and at men, transurethral endoscopic manipulation or sexual contact with the casual partner.
- Primary bacterial uretrit
Distinguish sharp and chronic bacterial uretrit. The course of sharp nonspecific inflammatory process differs from a clinical picture of a gonorrheal uretrit. Duration of the incubatory period can be various. Local signs of an inflammation are expressed not so brightly. Pain at an urination is characteristic, an itch, burning, purulent or mucopurulent allocations, insignificant hypostasis of a mucous urethra and the fabrics surrounding an external opening of an urethra.
It is necessary to remember that on the basis of a clinical picture and the character separated it is impossible to carry out differential diagnostics of a bacterial and gonorrheal uretrit. The diagnosis is exposed only at data acquisition of the laboratory researches confirming lack of gonokokk: on existence of gonorrhea, PTsR-diagnostics, etc.
The chronic inflammation of an urethra usually proceeds malosimptomno. The insignificant itch and burning at an urination is noted, poor mucous allocations and high resistance to therapy. The short and wide urethra at girls and women allows an infection to get freely into a bladder, causing cystitis which is diagnosed when performing ultrasonography of a bladder. At men chronic uretrit in certain cases becomes complicated kollikulity (an inflammation of a seed hillock). A seed hillock – the place of an exit of output channels of a prostate and semyavynosyashchy channels. Its inflammation can lead to a gemospermiya and frustration of an ejaculation.
- Secondary bacterial uretrit
The infectious agent gets into an urethra from the local center of an infection (in pelvic bodies, a bladder, prostate, seed bubbles) or at an infectious disease (quinsy, pneumonia). The long latent current is characteristic of a secondary nonspecific uretrit. Patients show complaints to weak morbidity at an urination, the poor allocations from an urethra of mucopurulent character which were more expressed in the mornings. At children of pain at an urination quite often are absent. At survey hyperaemia and pasting of sponges of an external opening of an urethra comes to light.
When carrying out two - or trekhstakanny test the first portion of urine muddy, contains a large number of leukocytes. In the second portion the quantity of leukocytes decreases, and in the third, as a rule, meets standard. For preliminary definition of character of microflora the bakterioskopichesky research separated from an urethra is conducted. For specification of a type of the infectious agent and his sensitivity to antibacterial medicines crops separated or washout are carried out from an urethra.
- Treatment of a bacterial uretrit
The modern urology has effective methods of therapy of a nonspecific uretrit. Tactics of treatment is defined depending on type of the activator, expressiveness of symptoms, existence or lack of complications. The combination of an uretrit to cystitis is the indication to complex therapy. At chronic nonspecific process reception of antibacterial medicines is supplemented with instillations in an urethra of solutions of a kollargol and nitrate of silver, the events directed to immunity normalization are held. The result of therapy at a secondary uretrit in many respects is defined by efficiency of treatment of the main disease (a striktura of an urethra, a vezikulit, prostatitis).
As a rule, develops as a result of the sexual intercourse with the infected partner, is more rare – by indirect contact through towels, sponges, linen, chamber-pots. Joint stay with the adult patient, use of the general toilet can be the cause of development of an infection in children.
- Symptomatology and clinical current
The first symptoms of a disease appear 3-7 days later from the moment of infection. Increase in the incubatory period up to 2-3 weeks is in some cases possible. Depending on duration of an infection allocate sharp (prescription of a disease less than 2 months) and chronic (prescription of a disease more than 2 months) gonorrhea.
Sharp gonorrheal uretrit usually begins suddenly. There are plentiful yellowish-gray purulent slivkoobrazny allocations from an urethra, gripes, burning and pain at an urination. At localization of inflammatory process in forward department of an urethra a condition of the patient satisfactory. Distribution of an inflammation on back department of an urethra is followed by a hyperthermia to 38-39 °C and the general symptoms of intoxication. Pains at an urination become more expressed.
Chronic gonorrheal uretrit develops:
- at patients with the uncured or not completely cured acute inflammation of an urethra of a gonokokkovy etiology;
- at patients with the weakened immunity;
- when involving in inflammatory process of a prostate and a back part of an urethra.
Weak expressiveness of symptomatology is characteristic of chronic inflammatory process. Patients are disturbed by an itch and insignificant burning in an urethra. The beginning of an urination is followed by the unsharp pricking pains. Allocations from an urethra poor, mucopurulent, generally in the mornings. The research of dabs demonstrates existence of gonokokk and secondary microflora.
At a chronic gonorrheal uretrit channels of paraurethral glands are quite often involved in process. The inflammation complicates outflow, leading to obstruction of channels, development of infiltrates, abscesses and osumkovanny cavities. The general condition of the patient worsens, sharp pains at an urination are characteristic.
The microscopy of allocations from an urethra is carried out. The diagnosis is confirmed in the presence of gonokokk (Neisseria gonorrhoeae) – gramotritsatelny bean-shaped aerobic diplococcuses. The standard research consists of two stages, includes coloring by a method of Gram and diamond green (or to methylene blue).
- Differential diagnostics
Diagnostics usually does not cause difficulties thanks to existence of characteristic symptoms (pain at an urination, purulent separated from an urethra). The differential diagnosis of a gonorrheal uretrit and inflammation of an urethra of other etiology is carried out (trikhomonadny, nonspecific uretrit etc.). Diagnostic criterion are results of a bakterioskopichesky research. In the anamnesis existence of sexual contacts with patients with gonorrhea comes to light.
Treatment of a gonorrheal uretrit is carried out by venereologists. Recently the increasing resistance of causative agents of gonorrhea to penicillin is observed. The greatest efficiency is noted at reception of tsefalosporin and ftorkhinolon. Recommend to the patient plentiful drink. Exclude alcohol, greasy and spicy food from a diet.
Chronic gonorrheal uretrit is the indication to the combined therapy. To the patient appoint antibacterial medicines and local treatment. At growth of granulyatsionny fabric and cellular infiltration (soft infiltrate) instillations are carried out to an urethra of solutions of a kollargol and nitrate of silver. At prevalence of cicatricial and sclerous processes (solid infiltrate) it is carried out buzhirovany urethras by metal buzha. The expressed granulations of times a week cauterize 10-20% silver nitrate solution via the urethroscope.
- Criteria of an izlechennost
In 7-10 days after completion of treatment conduct a bakterioskopichesky research separated urethras. If gonokokk are not found, carry out the combined provocation: biological (pirogenat or a gonovaktsina intramuscularly) and chemical (introduction to an urethra 0,5 solutions of nitrate of silver). Also provocation is applied mechanical (a forward uretroskopiya or introduction of a buzh to an urethra), thermal (warming up by induktotermichesky current) and alimentary (alcohol intake and greasy food).
Then daily within three days investigate a secret of a prostate gland, thread of urine and dabs from an urethra. In the absence of leukocytes and gonokokk provocation is repeated in 1 month. One more month later conduct the third, final control research. If clinical manifestations are absent, and gonokokk are not found at crops and a bacterioscopy, strike the patient off the register. The acquired immunity at gonorrhea is not formed. The person who in the past had a gonorrheal uretrit can repeatedly catch.
At the correct, timely treatment of a fresh gonorrheal uretrit forecast favorable. Upon transition of process to a chronic form and development of complications the forecast worsens. Gonokokkovy endotoxin has skleroziruyushchy effect on urethra tissues that can lead to formation (usually multiple) in a forward part of an urethra. – vazikulit frequent complications of a chronic inflammation of an urethra at gonorrhea, an epididymite, chronic prostatitis. Impotence, an epididymite outcome - infertility as a result of cicatricial narrowing of a semyavynosyashchy channel can become an outcome of prostatitis.
- Symptoms and diagnostics
Symptoms of a trikhomonadny uretrit appear 5-15 days later after infection. The slight itch, moderate whitish foamy allocations from an urethra is characteristic. The diagnosis is confirmed at detection of trichomonads (Trichomonas vaginalis) in the native and painted medicines. Investigate separated urethras, urethral scrape or a svezhevypushchenny first portion of urine. In native medicines the movements of zhgutik of trichomonads are well visible.
Quite often at a research of native medicine (especially at men) mobile trichomonads it is not possible to reveal. It is possible to increase reliability of a research, using additional methods (microscopy of the painted dabs, a research of crops).
Apply specific protivotrikhomonadny medicines, the most effective of which are metronidazole, and . The scheme of treatment depends on a condition of the patient, expressiveness of symptoms, existence of complications and the accompanying infections, sexually transmitted. Self-treatment is inadmissible as can promote transition of sharp process to chronic.
For the prevention of repeated infection at the same time carry out treatment of the constant sexual partner of the patient. During therapy and within one-two months after its termination recommend to the patient plentiful drink, exclude spicy food and alcohol from a diet. At a resistant chronic inflammation local therapy is appointed as the general, and. Within 5-6 days to the patient carry out instillations of 1% of solution of trichomonacide lasting 10-15 minutes.
In some cases at men the trichomoniasis proceeds asymptomatically or is followed by extremely poor symptomatology. Patients often do not suspect about the disease, and extend an infection among the sexual partners. The prostatitis worsening a condition of the patient and complicating treatment develops in 15-20% of cases at a chronic trikhomonadny uretrit.
A number of serotypes of Chlamydia trachomatis acts as the infectious agent. Hlamidiya settle down intracellularly that is characteristic of viruses, but existence of certain signs (DNA, RNA, ribosomes, a cellular wall) allows to classify these mikroogranizm as bacteria. Strike epitelialny cells of an urethra, neck of a uterus, vagina and conjunctiva. Are transferred sexually.
Chlamydial uretrit usually proceeds inertly, malosimptomno. Inflammatory process in an urethra in certain cases is followed by damage of joints and conjunctivitis (uretro-okulo-sinovialny a syndrome, a disease of Reuters). Diagnostic criterion is existence in the painted scrape from an urethra of semi-lunar intracellular inclusions.
Treatment. Problems at treatment of clamidiosis are connected with insufficient permeability of cellular membranes for the majority of antibiotics. Repeated demonstrations after treated are characteristic. For increase in efficiency antibiotics of a broad spectrum of activity combine with kortikosteroidny medicines (dexamethasone, Prednisolonum). The maximum dose of Prednisolonum - 40 mg/days, a course of treatment – 2-3 weeks. During a therapy course the dose of hormones is gradually reduced to full cancellation.
Drozhzhepodobny mushrooms act as the activator. The inflammation of an urethra of a fungal etiology meets seldom, usually is a complication after long-term treatment by antibacterial medicines. Sometimes develops after sexual contact with the woman who suffers from a kandidamikotichesky vulvovaginit. The risk of infection increases in the presence in the anamnesis of inflammatory diseases or injuries of an urethra.
The erased symptomatology is characteristic of a kandidamikotichesky uretrit. Patients show complaints to insignificant burning, a weak itch, whitish poor allocations from an urethra. The microscopy at sharp process reveals a large number of drozhzhepodobny mushrooms. At a chronic inflammation in a sample mycelium threads prevail. Therapy consists in cancellation of antibacterial medicines and purpose of antifungal means (nystatin, , ).