Pathogenesis (development of disease)
The exact pathomechanism of urethritis is still unknown. In women, it is thought that, among other factors, a reduction in lactobacilli from the vaginal flora (vaginal flora) favors colonization (colonization) with Escherichia coli. Factors that favor inflammation also include the length of the female urethra, proximity to the anus, pregnancy, and any type of drainage obstruction. In men, inflammation of the lower urinary tract is much less common. They usually occur only with urethral obstruction (narrowing of the urethra) or with heterosexual or homosexual anal intercourse/anal sex.
Etiology (causes)
According to etiology (cause), the following forms are distinguished:
Infectious urethritis
- Gonorrheic urethritis (GU; specific urethritis) – caused by the pathogen Neisseria gonorrhoeae* .
- Non-gonorrheic urethritis (NGU; non-specific urethritis).
The most common causative agents of NGU are:
- Chlamydia trachomatis* (serotypes D-K; 11-43%).
- E. coli
- Herpes simplex virus (2-3%)
- Ureaplasma urealyticum (20%)
- Mycoplasma genitalium* (9-25%)
- Enterococci
- Streptococci
- Staphylococci (Staphylococcus aureus)
- Trichomonas vaginalis (1-20%)
* The three most common pathogens of urethritis.
In very rare cases, an infection with Gardnerella vaginalis (bacterial vaginosis) in men can also lead to non-gonorrheal urethritis {1]. Furthermore, there are mycotic- (caused by a fungal infection) and protozoan-related (caused by parasites) urethritides.
Other forms of urethritis include (mod. by):
- Abacterial
- Allergic
Behavioral causes
- Nutrition
- Micronutrient deficiency (vital substances) – see Prevention with micronutrients.
- Sexual transmission
- Promiscuity (sexual contact with relatively frequently changing different partners or with parallel multiple partners).
- Prostitution
- Men who have sex with men (MSM).
- Sexual contacts in the vacation country
- Unprotected coitus (sexual intercourse)
- The insertion of foreign bodies into the urethra.
- Hygiene deficiencies – in the process, more often in women, germs can be carried from the intestine to the urethra
Disease-related causes
- Diabetes mellitus (diabetes)
- Urethral diverticulum – formation of a blind sac on the urethra.
- Urethral stricture (urethral narrowing).
- Reiter’s disease (synonyms: Reiter’s syndrome; Reiter’s disease; arthritis dysenterica; polyarthritis enterica; postenteritic arthritis; posturethritic arthritis; undifferentiated oligoarthritis; urethro-oculo-synovial syndrome; Fiessinger-Leroy syndrome; English Sexually acquired reactive arthritis (SARA)) – special form of “reactive arthritis” (see above. ); secondary disease after gastrointestinal or urogenital infections, characterized by the symptoms of Reiter’s triad; seronegative spondyloarthropathy, which is triggered especially in HLA-B27 positive persons by an intestinal or urinary tract disease with bacteria (mostly chlamydia); Can manifest as arthritis (joint inflammation), conjunctivitis (conjunctivitis), urethritis (urethritis) and partly with typical skin changes.
Other causes
