Skip to main content

Advertisement

SpringerLink
Log in

Urethritis in Women—Considerations Beyond Urinary Tract Infection

  • Inflammatory/Infectious Bladder Conditions (S Mourad, Section Editor)
  • Published:
Current Bladder Dysfunction Reports Aims and scope Submit manuscript

Abstract

Urethritis is a common condition affecting women in the USA. The symptoms, however, are not specific to a unique cause and are shared among a wide variety of urogenital diseases. This article evaluates the current literature and provides tools to the practicing clinician. Infections, particularly urinary tract infection and vaginitis, are common causes. The sexually transmitted infection Chlamydia trachomatis continues to be one of the most common etiologies for urethritis. Newer research provides evidence for the importance of Ureaplasma and Mycoplasma genitalium. Mechanical trauma, vaginal atrophy, chemical and mechanical exposure, and Skene’s gland and other anatomical pathology will also be reviewed. The diagnosis and treatment of urethritis often require the practitioner to treat associated diseases such as chronic pelvic pain syndrome and dyspareunia. Urethritis is intensely symptomatic leading to a pressured office interaction, and it is our intent to provide the tools for a comprehensive approach to female urethritis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. American Academy of Family Physicians. Urinary tract infections/dysuria. http://www.aafp.org/afp/topicModules/viewTopicModule.htm?topicModuleId=30, accessed 3/10/2014. This is an excellent resource for the general clinician or urologist for basic information about common causes of dysuria. It also addresses urinary tract infections.

  2. Grabe M, et al. Guidelines on urological infections. European Association of Urology, 2010.

  3. Andrews JC. Vulvodynia interventions—systematic review and evidence grading. Obstet Gynecol Surv. 2011;66(5):299–315. This is a broad review of both medical and surgical treatments for vulvodynia. Assessing the literature on vulvodynia interventions can be challenging but this review provides a solid platform for comparing different treatments.

    Article  PubMed  Google Scholar 

  4. Centers for Disease Control and Prevention. (2012). Chlamydia. Retrieved from http://www.cdc.gov/std/stats12/chlamydia.htm.

  5. United States Preventive Services Task Force. (2013). Screening for chlamydial infection. http://www.uspreventiveservicestaskforce.org/uspstf/uspschlm.htm

  6. Klein TA, Richmond JA, Mishell DR. Pelvic tuberculosis. Obstet Gynecol. 1976;48:99.

    CAS  PubMed  Google Scholar 

  7. Colabawalla SN. Reflections on urogenital tuberculosis. Indian J Urol. 1990;6:51–9.

    Google Scholar 

  8. Langemeier J. Tuberculosis of the genitourinary system. Urol Nurs. 2007;27(4):279–84.

    PubMed  Google Scholar 

  9. Hemal AK, Gupta NP, Rajeev TP, Kumar R, Dar L, Seth P. Polymerase chain reaction in clinically suspected genitourinary tuberculosis: comparison with intravenous urography, bladder biopsy, and urine acid fast bacilli culture. Urology. 2000;56(4):570–4.

    Article  CAS  PubMed  Google Scholar 

  10. McGowin CL and Anderson-Smits C. Mycoplasma genitalium: an emerging cause of sexually transmitted disease in women. Plospathogens, May 2011, Volume 7, Issue 5. This organism is not often taught as a cause of sexually transmitted disease. The article provides in depth information regarding epidemiology and symptoms.

  11. Falk L et al. Signs and symptoms of urethritis and cervicitis among women with or without Mycoplasma genitalium or Chlamydia trachomatis infection. Sex Transm Infect. 2005;81:73–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  12. Jalal H et al. Molecular epidemiology of selected sexually transmitted infections. Int J Mol Epidemiol Genet. 2013;4(3):167–74.

    PubMed Central  PubMed  Google Scholar 

  13. Bjornelus E, Anagrius C, Carlberg H, Johannisson G, et al. Antibiotic treatment of symptomatic Mycoplasma genitalium infection in Scandinavia: a controlled clinical trial. Sex Transm Infect. 2008;84:72–6.

    Article  Google Scholar 

  14. Yoshida T, Deguchi T, Meda S, et al. Quantitative detection of Ureaplasma parvum (biovar 1) and Ureaplasma urealyticum (biovar 2) in urine specimens from men with and without urethritis by real-time polymerase chain reaction. Sex Transm Dis. 2007;34(6):416–9.

    Article  PubMed  Google Scholar 

  15. The detection and management of vaginal atrophy. SOGC Clinical Practice Guidelines. International Journal of Gynecology and Obstetrics 2005;88:222–228.

  16. Burrows LJ et al. The effects of hormonal contraceptives on female sexuality: a review. J Sex Med. 2012;9:2213–23. jsm_2848 2213.

    Article  CAS  PubMed  Google Scholar 

  17. Walker C, Badawy SZ. Vaginal atrophy following long-term depot medroxyprogesterone acetate use: a case report. Case Rep Obstet Gynecol. 2013;2013:835316.

    PubMed Central  PubMed  Google Scholar 

  18. Iosif CS, Batra S, Ek A, Astedt B. Estrogen receptors in the female urinary tract. Am J Obstet Gynecol. 1981;141:817–20.

    CAS  PubMed  Google Scholar 

  19. MacBride M et al. Vaginal atrophy. Mayo Clin Proc. 2010;85(1):87–94.

    Article  Google Scholar 

  20. Raz R, Stamm WE. A controlled trial of intravaginal estriol in postmenopausal women with recurrent urinary tract infections. N Engl J Med. 1993;329:753–7.

    Article  CAS  PubMed  Google Scholar 

  21. Ouslander JG, Greendale GA, Uman G, Lee C, Paul W, Schnelle J. Effects of oral estrogen and progestin on the lower urinary tract among female nursing home residents. J Am Geriatr Soc. 2001;49(6):803–7.

    Article  CAS  PubMed  Google Scholar 

  22. Salam MA. Principles and practice of urology: a comprehensive text (volume 1) Parkland: Brown Walker Press, 2003.

  23. Egan ME, Lipsky MS. Diagnosis of vaginitis. Am Fam Physician. 2000;62(5):1095–104.

    CAS  PubMed  Google Scholar 

  24. Hainer BL, Gibson MV. Vaginitis. Am Fam Physician. 2001;8(7):807–15.

    Google Scholar 

  25. Kennedy CM et al. Bladder and bowel symptoms among women with vulvar disease: are they universal? J Reprod Med. 2007;52(12):1073–8.

    PubMed  Google Scholar 

  26. Berger MB et al. Rates of self-reported urinary, gastrointestinal, and pain comorbidities in women with vulvar lichen sclerosus. J Lower Genit Tract Dis. 2012;16(3):285–9.

    Article  Google Scholar 

  27. Chronic female pelvic pain—part 2: clinical pathoanatomy and examination of the pelvic region. Pain Practice. 2012;12(2) 88–110. This encompassing, two-part publication provides an excellent guide to approaching female urogenital pain as well as a review of various treatment modalities.

  28. Apte G et al. Chronic female pelvic pain—part 1: clinical pathoanatomy and examination of the pelvic region. Pain Practice. 2012;12(2):88–110. This encompassing, two-part publication provides an excellent guide to approaching female urogenital pain as well as a review of various treatment modalities.

    Article  PubMed  Google Scholar 

  29. Foster DC, Kotok MB, Huang LS, Watts A, Oakes D, Howard FM, et al. Oral desipramine and topical lidocaine for vulvodynia: a randomized controlled trial. Obstet Gynecol. 2010;116:583–93.

    Article  CAS  PubMed  Google Scholar 

  30. ACOG Committee on Gynecologic Practice. ACOG Committee Opinion: vulvodynia. Obstet Gynecol. 2006;108(4):1049–52. Number 345, October 2006.

    Article  Google Scholar 

  31. Polpeta NC et al. Clinical and therapeutic aspects of vulvodynia: the importance of physical therapy. Minerva Ginecol. 2012;64(5):437–45.

    CAS  PubMed  Google Scholar 

  32. Rovner ES. Urethral diverticula. In: Raz S, Rodriguez L, editors. Female urology. 3rd ed. Philadelphia: Saunders; 2008. p. 815–34.

    Google Scholar 

  33. Patel AK, Chapple CR. Female urethral diverticula. Curr Opin Urol. 2006;16:248–54.

    Article  PubMed  Google Scholar 

  34. Dwarkasing RS et al. MRI evaluation of urethral diverticula and differential diagnosis in symptomatic women. AJR Am J Roentgenol. 2011;197(3):676–82.

    Article  PubMed  Google Scholar 

  35. Yang JM et al. Transvaginal sonography in the diagnosis, management and follow-up of complex paraurethral abnormalities. Ultrasound Obstet Gynecol. 2005;25:302–6.

    Article  PubMed  Google Scholar 

  36. Shah SR et al. Surgical management of Skene’s gland abscess/infection: a contemporary series. Int Urogynecol J. 2012;23(2):159–64. There is not a great deal written on Skene’s gland pathology. This article provides insight from one of the largest series.

    Article  PubMed  Google Scholar 

  37. Santucci R, Chen M. Evaluation and treatment of female urethral stricture disease. Curr Bladder Dysfunct Rep. 2013;8(2):123–7.

    Article  Google Scholar 

  38. Davis R, et al. Diagnosis, evaluation and follow-up of asymptomatic microhematuria (AMH) in adults: AUA guideline. American Urological Association Education and Research, Inc.®, 2012.

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Jeffrey Gilbert and William Ulmer declare that they have no conflicts of interest. Elise De reports financial relationships outside of the submitted work with the following companies: Astellas, Allergan, American Medical Systems, AMGEN, Boston Scientific, Ferring, Welch’s Grape Juice, Capital Region Medical Research Foundation, and United BioSource Corporation.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Albany Medical Center, Albany, NY, 12208, USA

    W. D. Ulmer & E. J. B. De

  2. BioReference Laboratories, Elmwood Park, NJ, USA

    J. L. Gilbert

Authors
  1. W. D. Ulmer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. L. Gilbert
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. E. J. B. De
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to E. J. B. De.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ulmer, W.D., Gilbert, J.L. & De, E.J.B. Urethritis in Women—Considerations Beyond Urinary Tract Infection. Curr Bladder Dysfunct Rep 9, 181–187 (2014). https://doi.org/10.1007/s11884-014-0246-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11884-014-0246-7

Keywords

Search

Navigation