• Urethritis, or inflammation of the urethra, is caused by an infection characterized by the discharge of mucoid or purulent material and by burning during urination.
•  However, asymptomatic infections are common. 

2. What are the major causes of urethritis? 

The two bacterial agents primarily responsible for urethritis among men are 

• Neisseria gonorrhea 
• Chlamydia trachomatis. 

less common

• Ureaplasma urealyricum 
• Herpes simplex virus 

3. Can gonococcal infection be excluded on the basis of the information presented? 

• Gonococcal infection cannot be completely excluded in this care.
• Gram stain of urethral discharge will be positive in 95% of symptomatic men with gonococcal urethritis.  

4. Define nongonococcal  urethritis. 

• Nongonococcal urethritis, or inflammation of the urethra not caused by gonococcal infection, is characterized by a mucoid or purulent urethral discharge. 
• In the presence or absence of a discharge, NGU may be diagnosed by > 5 PMN per oil immersion field in a smear of an intraurethral swab specimen.
•  C. trachomatis is the most frequent cause of NGU (23-55% of cases); however, prevalence varies among age groups, with lower prevalence found among older men. 
• U. urealyticum causes 20-40 % of cases, and Trichomonas vaginalis 2-5% herpes simplex virus is occasionally responsible for cases of NGU.

5. Define postgonoccccal urethritis. 

• Postgonococcal urethritis refers to the clinical syndrome in which symptoms recur after treatment for gonorrhea.
• It is a manifestation of dual urethral infection. 
• Chlamydia trachomatis has been recovered from 11-50% of men with gonorrhea. Occasionally, dual infection with ureaplasma may occur.

6. Describe the general characteristics of Chlamydia species

• Chlamydia are small, rounded organisms that show morphologic variation during their replicative cycle. 
• The cell envelope is similar to Gram-negative bacterial types but the outer membrane lacks peptidoglycan.
• They are obligate intracellular bacteria that fail to grow outside in artificial media. 
• They are metabolically deficient compared with free-living bacteria, because they require the host-derived ATP for survival. 

7. Name the three species of Chlamydia species

The three species are 

• C. psittaci
• C. trachomatis
• C. pneumoniae.
  
  

8. Describe the reproduction cycle of Chlamydia. 

•  It has two forms of the organism, an elementary body and a larger intracellular replicative reticulate body.
• The elementary body infects cells by its attachment to the plasma membrane. 
• Host cell metabolism is used during the entry. 
• The elementary body transforms to a reticulate body by protein modification.
• Reticulate bodies then divide by binary fission within the endocytic vacuole. 
• The newly formed organisms condense to yield multiple elementary bodies with the capacity to infect other host cells when it ruptures.
  
  

9. Other serovarieties of C. trachomatis can cause infection -

10. What other sites can be involved with sexually transmitted Chlamydia trachomatis? 

Other sites include 

• cervicitis
• endometritis
• salpingitis 
• proctitis
• epididymitis 
• pelvic inflammatory disease
  

11. List the serovarieties, the diseases they cause, and how each is transmitted.  

• Serovarieties A, B, Ba and C cause trachoma, a chronic conjunctivitis that often leads to blindness. 
  • Spread is via hand to eye contact with infected secretions.
• Serovarieties D-K cause inclusion conjunctivitis and infant pneumonia, which is acquired during passage through an infected birth canal.
• Serovarieties L₁, L₂ and L₃ cause lymphogranuloma venereum, a sexually transmitted disease.

12. How would you treat this patient? 

• Tetracycline (especially doxcycline) and erythromycin are commonly used. 
• Azithromycin is effective given as a single dose, but is expensive. 
• Ciprofloxacin may be used in adults. 
• In pregnant women and infants, erythromycin is used because of tooth staining of the fetus or infant with tetracycline.