WHAT IS THE CAUSE FOR GONOCOCCAL URETHRITIS, HOW DOES IT SPREAD, WHAT ARE THE SYMPTOMS?

The cause for gonococcal urethritis is Neisseria gonorrhea, a gram negative diplococcus. The most common cause for gonococcal urethritis is sexual intercourse. For a man, infection risk after a single intercourse with an infected partner is about 17 to 20% although the possibility of infection from an infected men to a woman is 80%. When number of sexual intercourse with a porter or infected partner increases, risk also increases. Cases infected with secretions without vaginal intercourse have been reported as well.

Symptoms and Findings

* Burning sense while urinating

* Urethral efflux (Efflux is generally inflamed, yellow to brown colored and much)

HOW IS GONOCOCCAL URETHRITIS DIAGNOSED?

1 to 4 hours after the patient has urinated, a special culture stick is inserted into the urethra about 2 to 4 cm and turned. Gram staining and planting into the culture medium from samples are performed. 2 separate samples are collected if necessary. Gram-negative diplococcus are seedn in the gram staining. An accurate diagnosis may be determined with 95%.

WHAT MAY GONOCOCCAL URETHRITIS CAUSE IF LEFT UNTREATED? HOW SHOULD BE PROTECTED FROM INFECTION CAUSES?

If required treatment is not performed

* Periurethritis, periurethral abscess

* Urethral stenosis

* Prostatitis, prostate abscess, epididymitis, proctatitis and arthritis may be seen.

Gonorrhea may be prevented with regular condom use and antibiotic after the intercourse, intravaginal antiseptic agents or antibiotic application.

WHAT US THE CAUSE FOR NON-GONOCOCCAL URETHRITIS, WHAT ARE SYMPTOMS? HOW IS IT TREATED?

When N. gonorrhea can not be shown by the culture or gram staining in presence of urethritis, non-gonococcal urethritis is diagnosed.

The most important and dangerous cause is Chlamydia trachomatis. This bacteria may be shown in 25 to 60% of men with NGU and 4 to 35% of men with gonorrhea in urethra. There is not any pathology ,n 50% of Chlamydia infections, but patients are porter.

In 20 to 50% of the patients, the cause for NGU is Ureaplasma urealyticum.

Symptoms:

* Urethral efflux (efflux is generally less, thin and mucoid)

* Dysuria (burning sense while urinating) and urethral itching and stinging sense.

Treatment:

Tetracycline , doxycycline or erythromycin may be used.

To be protected from NGU is limited with condom like in gonorrhea and vaginal spermicidal agents. Treatment of the patient with her/his sexual partners are very important.

WHAT IS THE CAUSE FOR TRICHOMANIASIS, WHAT ARE THE FINDINGS? HOW IS IT TREATED?

Trichomonas vaginalis causes the disease. Incidence is 2%. T is most common between 15 and 40 years of life in men and women. It spreads with sexual intercourse and it was found with a ratio of 14 to 60% in male partners of infected women and of 67 to 100% in female partners of infected men. It mostly progresses without any symptom in men.

Condom should be used until the treatment is completed successfully. Metronidazole is given to the patient and her partner. Treatment response is taken immediately. Treatment of partners earnestly is very important.

WHAT IS CHANCROID (ULCUS MOLLE, SOFT CHANCRE), WHAT ARE FINDINGS? HOW IS IT TREATED?

It is caused by Haemophilus ducreyi.

The first symptom of chancroid is the papule seen on several days after the sexual intercourse. Then, single or multiple, painful chancroid ulcers with a dirty appearance appear. They cause inflamed efflux in general. The patients have fever, headache and fatigue.

Ulcers not treated grow slowly, bursts and combine with the others. It causes painful groin inflammation and lymphatic obstruction; and genital edema and further elephantiasis develop.

Treatment:

Azithromycin 1 g. Single dose, erythromycin 500 mg. For 4 x 17 days, certraixone 250 mg may be used as single dose.

WHAT IS SYPHILIS? WHAT ARE THE SYMPTOMS AND HOW IS IT TREATED?

Syphilis is caused by a spirochete called Treponema pallidum. T. pallidum enters into the body by skin and mucosa and a painless chancre ( a wound seems like a hole made by a staple) on the penis at 2 to 4 weeks after the sexual intercourse. If not treated, lesion recovers slowly by itself. There may be unilateral or bilateral, separate, painless lymphadenopathy on the inguinal region. Urological complications are rare and seen at the 3rd phase of the disease. These include testicle gummas and neurogenic bladder seen in neurosyphilis.

Penicillin G is given to the patients with early syphilis. Doxycycline or tetracycline is given to those with penicillin allergy.

WHAT IS LYMPHOGRANULOMA VENEREUM? WHAT ARE THE FINDINGS? HOW IS IT TREATED?

The cause is Chlamdyda Trachomatis. Genital lesion, lymphadenitis and rectal stenosis may be seen. A papule or pustule appears at 5 to 21 days after the sexual intercourse. Genital lesion is small and generally not noticed. Reproduction of C. trachomatis in the culture is diagnostic. Treatment: Doxycycline, 100 mg. 2×1, for 3 weeks.

WHAT IS GRANULOMA INGUINALE? WHAT ARE THE FINDINGS? HOW IS IT TREATED?

The cause is Calymmatobacterium granulomatis (Donovan body) and incubation period is 2 to 3 months.

Clinical Findings

Papule is the first symptom. A painless, tumorous, hard, indurated, painless ulcer including hemorrhagic secretion with an eritematous base occurs. Observation of Donovan bodies in stained smear is diagnostic.

Treatment:

Tetracycline 500 mg. 4×1 or trimethoprim-sulfamethoxazole (160/800 mg. tablet) 2×1 are applied until the lesions recover.

WHAT IS CONDYLOMA ACUMINATA (WART)? HOW IS IT TREATED?

The cause is HPV (Human papilloma virus). Incubation period may be 1 to 2 months. Diagnosis is very easy by observing the lesion.

Location, size and number of the lesions are important for the treatment.

Topical creams: Podophylin – imiquimod cream, trichloracetic acid may be used.

Cryotherapy: Lesions may be destroyed without pain within a couple of sessions.

Surgical: Removal of the lesions completely one by one and cauterization of the wart base is the most efficient therapy. It may be applied in the office under local anesthesia.

* It is possible to cauterize urethral warts endoscopically.

MAY TUBERCULOSIS AFFECT URINARY TRACTS AND HOW DOES IT DEVELOP? WHICH SYMPTOMS DOES IT PRESENT?

Genital tuberculosis is a slow progressing disease and appears at 15 to 20 years after the primary pulmonary infection in general. Pollakiuria (frequent urination), urgency (urgent urination desire), nocturia (awakening for urination at night), dysuria (burning sense while urinating) may be detected. 50% of the patients have macroscopic hematuria (visual urinary bleeding). These symptoms may not be seen until the disease progresses to the further stage; even though patients may be asymptomatic. Pain is an indicator for a progressed disease. Most symptoms are connected with dissemination of the bacilli into the bladder. Some Clinical Findings For Genitourinary Tuberculosis

* Sterile pyuria

* Painless and frequent urination at nights

* Previous or active tuberculosis on another part of the body

* Unexplained hematuria

* Chronic cystitis irresponsive to antibiotics

* Chronic epididymitis including nodules in the epididymis and/or thick ductus deference or palpation of formations like rosary beads

* Waned nodular prostate

* Indurations on seminal vesicles

* Mild iliac pain / renal colic

Scrotal sinuses including chronic efflux

HOW IS GENITOURINARY TUBERCULOSIS DIAGNOSED? HOW IS THE TREATMENT PLANNED?

* The standard test for the diagnosis is intravenous pyelography (IVP) and provides an abnormal findings in 93% of the patients. Ulcer and nodules which have generally located around ureter orifices and are smaller than 3 mm may be detected in the cystoscopy. Treatment: Different combinations of antituberculosis drugs Isoniazid (INH),.Ethambutol, Rifampin, Streptomycin, Pyrazinamide is continued for 9 months.

WHAT IS ORCHITIS, EPIDIDYMORCHITIS? HOW DOES IT DEVELOP, WHAT ARE THE SYMPTOMS ?

Orchitis is inflammation of the testicles and epididymitis is inflammation of the epididymis. Generally, both appears together. Infections are the most important causes.

The virus may settle into the testicle via bloodstream in 20% of the children who had mumps.

Bacterial Infection: Urinary infection may come to the testicle and settle there in some cases via vas deference.

Prostatic and urethral infections may also settle into the testicle via vas deference path. The most common causes are Chlamdia and Gonorrhea infections which are sexually transmitted.

When sufficient antibiotherapy is not applied after prostate and urethra operations, microorganisms may also settle into the testicle.

Some germs within the body such as tuberculosis may come to the testicle and settle there via bloodstream even rare.

HOW ARE ORCHITIS AND EPIDIDYMORCHITIS TREATED?

Treatment should be done according to the cause. If it is viral origin; bedrest and analgesic agents should be done; and if the cause is bacteria, antibiotic and abovementioned recommendations should be applied. In a tuberculosis dependent infection, phthisis specific treatments should be used.