Understanding Urethritis and Cervicitis

Primary Causes of Urethritis and Cervicitis

Gonorrhea and chlamydia are the leading causes of urethritis in men and cervicitis in women. Both infections are frequently encountered in sexually transmitted infection cases, with Chlamydia trachomatis and Neisseria gonorrhoeae identified as the primary pathogens.

Co-infection and Treatment Recommendations

It is common for patients diagnosed with gonorrhea to also be co-infected with chlamydia. The World Health Organization advises that individuals be treated for both infections as a precaution. Infected individuals’ partners must also undergo testing and treatment, even if they do not exhibit symptoms.

Recent Updates to Canadian Guidelines

Recent modifications to the Canadian guidelines for gonorrhea treatment, as reported by the Canadian Pharmacists Association, recommend that all partners from the last 60 days be referred for treatment. Both the infected person and their partner should abstain from sexual contact for at least one week following the start of treatment.

Symptoms and Complications

Symptoms in Men

Men with urethritis typically experience symptoms such as painful urination and penile discharge. Complications can include epididymitis, prostatitis, and, in severe cases, systemic infections characterized by fever. The presence of simultaneous inflammation of the epididymis and testes necessitates precautionary treatment for both gonorrhea and chlamydia.

Symptoms in Women

Women suffering from cervicitis may display symptoms like excessive vaginal discharge, painful urination, heavy menstrual bleeding, and intermenstrual bleeding. Complications can lead to pelvic inflammatory disease, ectopic pregnancy, and infertility. Screening for chlamydia is crucial in high-risk women, particularly those who are young, sexually active, or have multiple or new sexual partners, as the infection often shows no symptoms. Approximately 20% of women with gonorrhea may develop pelvic inflammatory disease, with some experiencing infertility as a consequence.

Changes in Treatment Protocols

Fluoroquinolones No Longer Preferred

Fluoroquinolones have been removed from the list of preferred treatments for gonococcal infections in Canada. They should only be used as an alternative if resistance is below 5% or if susceptibility is confirmed.

Current Treatment Recommendations

The current recommended treatment for gonorrhea-related anogenital infections involves a combination of injectable ceftriaxone and the oral antibiotic azithromycin. For patients with allergies to cephalosporin antibiotics, those with anaphylactic reactions to penicillin, or cases of gonorrhea resistant to cephalosporins, the preferred regimen is a combination of azithromycin and gentamicin. Additionally, Canadian guidelines stipulate that infected individuals should be screened again six months after completing gonorrhea treatment.

Conclusion

Understanding the implications of gonorrhea and chlamydia infections is crucial for effective treatment and prevention. Regular screening and updated treatment protocols play a vital role in managing these sexually transmitted infections.

Written by Kimberly Spencer B.Sc. (Hons)

References

(1) CPhA e-T Highlight. (2017) Retrieved 25 November 2017, from https://www.myrxtx.ca/cpha-content/new/documents/CHAPTER/en/c0099?elementId=c0099n99107&userType=CFPC&profileId=762600#c0099n99107
(2) WHO | Public health round-up. (2017). Retrieved 27 November 2017, from http://www.who.int/bulletin/volumes/90/9/12-010912/en/