Urethritis natural history, complications and prognosis

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Overview

Urethritis has a good prognosis and most patients are treated with appropriate antibiotics. If left untreated, it can resolve within 3 months in 95% of people with gonococcal urethritis. The symptoms of nongonococcal urethritis generally abate within 3 months in 30-70% of untreated people. Rarely, complications such as epididymitis, prostatitis, urethral stricture, chronic gonorrhea carrier state, may occur.

Natural History, Complications, and Prognosis

Natural History

  • If left untreated, it can resolve within 3 months in 95% of people with gonococcal urethritis. The symptoms of nongonococcal urethritis generally abate within 3 months in 30-70% of untreated people.[1]
  • Prolonged asymptomatic urethral carriage of gonococci occurs in 2% to 3% of newly infected men if left untreated.[2]

Complications

Common complications of urethritis include:

  • It occurs in 20% to 30% of men with non-gonorrheal urethritis (NGU); however, it is usually asymptomatic and responds to standard treatment.[3]
  • Urethral stricture
  • Oculogenital syndrome
  • Consisting of conjunctivitis and non-gonorrheal urethritis (NGU) may be seen in approximately 4% of patients with urethritis.[4]
  • Associated with nongonococcal urethritis in 1% to 2% of cases, primarily in men and is strongly associated with HLA-27.[5]

Prognosis

  • The prognosis is generally good following standard therapy.

References

  1. Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 9781455748013.
  2. Detels R, Green AM, Klausner JD, Katzenstein D, Gaydos C, Handsfield H, Pequegnat W, Mayer K, Hartwell TD, Quinn TC (2011). "The incidence and correlates of symptomatic and asymptomatic Chlamydia trachomatis and Neisseria gonorrhoeae infections in selected populations in five countries". Sex Transm Dis. 38 (6): 503–9. PMC 3408314. PMID 22256336.
  3. Holmes KK, Handsfield HH, Wang SP, Wentworth BB, Turck M, Anderson JB, Alexander ER (1975). "Etiology of nongonococcal urethritis". N. Engl. J. Med. 292 (23): 1199–205. doi:10.1056/NEJM197506052922301. PMID 165407.
  4. Rönnerstam R, Persson K (1982). "Chlamydial eye infection in adults". Scand J Infect Dis Suppl. 32: 111–5. PMID 6958007.
  5. Carter JD, Gérard HC, Espinoza LR, Ricca LR, Valeriano J, Snelgrove J, Oszust C, Vasey FB, Hudson AP (2009). "Chlamydiae as etiologic agents in chronic undifferentiated spondylarthritis". Arthritis Rheum. 60 (5): 1311–6. doi:10.1002/art.24431. PMC 2757404. PMID 19404948.
  6. Holmes, King (2008). Sexually transmitted diseases. New York: McGraw-Hill Medical. ISBN 978-0071417488.