Infectious causes: urogenital herpes
Inflammation of the urethra in women is rarely isolated. In urogenital herpes, the inflammatory process involves various parts of the reproductive and urinary systems: in addition to urethritis, vulvovaginitis, endometritis, and salpingitis develop, and bladder involvement is also possible.
Local complaints come to the forefront—patients report marked itching and burning in the genital area. The systemic infection toxicity syndrome is mild, but objectively, a local lymphoid tissue reaction in the form of inguinal lymphadenopathy may be detected. Treatment tactics for simple herpes are strictly individualized and depend on the clinical form, severity, and exact localization of the lesions.
Gonococcal infection and its consequences
Gonorrhea is another frequent cause of urethral involvement. A feature of the modern presentation of gonorrhea is the absence of typical clinical signs in the majority of cases and the predominance of mixed infections. This leads to a prolonged incubation period, more frequent recurrences, and significantly complicates diagnosis and treatment.
If the infection spreads via the ascending route, severe complications develop:
- Endomyometritis: the uterus becomes enlarged, tender, and somewhat soft.
- Salpingo-oophoritis: the adnexa become edematous and tender (the risk of abscesses is higher with intrauterine contraception).
- Peritonitis: symptoms of peritoneal irritation appear.
Chronification of the inflammatory process leads to pelvic adhesions, menstrual irregularities, infertility, ectopic pregnancy, pregnancy loss, and chronic pelvic pain syndrome.
Traumatic injuries of the urethra in women
Urethral trauma in women is significantly less common than in men (in whom it accompanies up to 10% of major pelvic fractures). The lower risk is due to a different female pelvic floor configuration and a shorter urethra.
However, in pelvic fractures, urethral trauma should be suspected if the following clinical signs are present:
- Vaginal bleeding.
- Marked edema of the labia.
- Difficulty urinating.
- Blood at the external urethral meatus and hematuria.
- Urinary leakage through the rectum.
Important rule: visualization of the urethra (retrograde urethrography using a low-osmolar contrast agent) must precede catheterization. Missed urinary tract injuries threaten serious complications: infections, pelvic abscesses, vesicovaginal/vesicocervical fistulas, and urinary incontinence.
Laboratory diagnostics
To identify the pathogen, material is collected from three loci: the urethra, vagina, and cervical canal.
Diagnosis of gonorrhea: Bacterioscopy aims to detect diplococci. Due to the high variability of the gonococcus, the method of choice is bacteriological culture on artificial (including selective with antibiotics) nutrient media. If immediate plating is not possible, a transport medium is used. Grown cultures must be tested for antibiotic sensitivity.
Diagnosis of herpes: Includes four groups of methods:
- Cytomorphological: Romanowsky-Giemsa staining reveals giant multinucleated cells (syncytia) and specific Cowdry cells with intranuclear inclusions.
- Virological: evaluates the cytopathic effect on cell culture (He-La, Hep-2, fibroblasts) within 24 hours. Identification is performed via DFA and ELISA.
- Serological: evaluates the rise in antibody titer in paired sera.
- Molecular biological: application of PCR for direct identification of the viral genetic material.
Differential diagnosis: In the presence of discharge, it is important to exclude bacterial vaginosis, which is characterized by "clue" cells, a decrease in lactobacilli, pH > 4.5, and a positive amine test (fishy odor upon adding KOH).
The PVG rule for identifying gonococci in a smear: Paired arrangement (diplococci), Intracellular location (inside neutrophils), Gram-negative (gram-negative staining).
Class and exam questions
How to distinguish primary herpetic urethritis from a recurrence using a blood test?
In serological testing, a 4-fold or greater increase in immunoglobulin M (IgM) titer indicates a primary infection, whereas a rise in IgG titer indicates a recurrent form of the disease.
Why is it forbidden to immediately insert a urinary catheter when urethral trauma is suspected?
Up to 23% of urethral injuries are missed on initial examination. Imaging (e.g., retrograde urethrography) must strictly precede catheterization so that a mistakenly placed catheter does not exacerbate a rupture.
Should a male partner be treated if bacterial vaginosis is detected in a woman?
Treating men to prevent recurrences of vaginosis in women is inappropriate. However, if a man has symptoms, urethritis cannot be ruled out—in this case, examination and treatment are required according to indications.
What else to study on this topic
- Severe forms of herpetic infection: aseptic meningitis and encephalitis
- Amsel and Nugent criteria in the diagnosis of bacterial vaginosis
- Two-stage treatment regimen for bacterial vaginosis (eradication and microflora restoration)
- Radiological signs of urethral trauma: the "shepherd's crook" sign and contrast extravasation
- Goldman & Sandler classification of urethral injuries
Master the complete topic in the «Infectious Diseases» course
This is a summary. The course covers everything tested in classes and exams.
- Complete study guide on "Urethritis in women" and 3,312 more pages of the subject
- Assignments and quizzes after every topic — just like in a colloquium
- AI tutor answers questions on the topic anytime
- 41 video lessons on the subject
Other topics in the "Additional Topics" section
Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.