Male urethritis:
The definition is cytological: ≥ 10 PNN on the review of the first urine stream at a magnification of 400 and at least 5 PNN mile magnification; serous or purulent urethral discharge; ductal pruritus; burning on urination; urinary frequency; dysuria.
Gonococcal urethritis:
– The transmission is still sexual; Incubation is short (always <5 days)
– The symptoms are usually noisy with a purulent urethral discharge; marked dysuria (clap, gonorrhea)
– There is neither ADP nor fever
– The diagnosis is easily made by direct examination of smears flow
– There is no reliable serology of gonococcal infections
– NB: gonococcal cervicitis (in women) are frequently asymptomatic; smear-positive in only 20% of cases.
– Complications: epididymoorchitis; prostatitis; sepsis; conjunctivitis
– Antibiotics: ceftriaxone, cefixime, ciprofloxacin, spectinomycin. (Gonococcal pharyngitis should be treated with ceftriaxone)
– An anti-chlamydial therapy should be systematically deputy anti-gonococcal treatment
SEPTICEMIA GONOCOCCAL:
– Low-grade fever; arthralgia; tenosynovitis; skin lesions (pustules)
– After a few days -> arthritis (infectious oligoarthritis)
– More rarely: SPM; hepatitis; meningitis; myocarditis; endocarditis
Chlamydia trachomatis urethritis:
– The C. trachomatis is the most common bacterium urethritis gono non-coccal; it is also the leading cause of urethritis
– Incubation lasts 10 to 15 days
– In the majority of cases the infection is asymptomatic
– Urethritis with clear discharge, moderate or no symptoms urethral discharge.
– This is the only seed in the charge of serious complications UNG
– The diagnosis is difficult; direct examination slide is impossible. The gold standard is the cell culture media (HeLa cell); rapid reviews (immunofluorescence) are less sensitive and less specific
– The serology of C. trachomatis have no interest in uncomplicated forms (poor sensitivity, cross-reactions with C. trachomatis)
– NB: C. trachomatis is the leading cause of mucopurulent cervicitis; is completely identical to gonococcal cervicitis
– Complication: epididymoorchitis; prostatitis; Fiessenger Reiter syndrome
– NB: For women -> salpingitis; Fitz-Hugh-Curtis syndrome (perihepatitis) with acute cholecystitis table with peritoneal involvement (-> Dc: laparoscopy)
NB: C. trachomatis is the primary etiology of neonatal pneumonia
Fiessenger syndrome Reiter:
– Reactive arthritis after urethritis with sex ratio = 50/1 (man )
– And combining bilateral conjunctivitis
– Asymmetric arthritis (especially the large joints of MI) with heel pain; axial involvement and tendonitis. Inflammatory joint fluid is sterile.
– Mucocutaneous signs (common): balanitis; psoriasiform lesions
– HLA B27 in 70% of cases