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Posterior urethritis is diagnosed in prepubertal or pubertal boys mainly with terminal asymptomatic haematuria or postmicturition blood spotting on the meatus or in the underwear. It presents with typical changes in the bulbar urethra (hyperaemia, oedema and denuded mucosa) without laboratory or radiological findings. The pathology is self-limiting with a very good prognosis. This condition is most likely caused by dysfunctional voiding and urotherapy with biofeedback therapy offers good treatment results. Although urethrocystoscopy is the only way to confirm the diagnosis, the patient should be prevented from having a (usually unnecessary) urethrocystoscopy and the relatives should be reassured., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

A broad spectrum of bacteria, fungi, protozoa and viruses can cause urethritis. In particular, N. gonorrhoeae, C. trachomatis, M. genitalium and T. vaginalis are the focus of diagnostic considerations as classic pathogens associated with sexually transmitted infections (STI). A step-by-step procedure is needed to make a definitive diagnosis. Microscopy with a staining preparation provides an initial differentiation between gonoccocal and non-gonococcal urethritis in symptomatic men as a point-of-care (POC) test. Nucleic acid amplification technology (NAAT) is used for specific and sensitive pathogen detection and, as a multiplex diagnostic test, offers the possibility of detecting several organisms from the same sample. In addition, compared to culture, no vital organisms are required, which allows the collection and use of more diverse and less invasive biological samples (e.g. first stream urine in men or vaginal swabs). Susceptibility testing by culture remains essential for N. gonorrhoeae as resistance is emerging. The treatment of urethritis depends on the suspected or proven pathogen according to the current guidelines. Treatment failure can be caused by many factors (coinfection, lack of therapy adherence, reinfection or resistance of the pathogen) and requires a repeated diagnostic and therapeutic procedure and differentiated approach., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Urethritis is mainly caused by sexually transmitted pathogens, such as Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) [1]. Close to 90 million adults are infected annually with NG [2]. Treatment shall be performed according to national guidelines and resistance profiles [2, 3]. Enterobius vermicularis (EV) is the most common helminth in humans with 1 billion people globally infected [4-6]. Symptoms include anal pruritus; however, many infections are asymptomatic [4-7]. A case of urethritis due to simultaneous infection with NG and EV is reported., (© 2022. The Author(s).)

Urethritis posterior is a possible cause of asymptomatic haematuria in prepubescent boys. It is a benign lesion of the posterior urethra and its cardinal symptoms are blood spots in the underwear without any laboratory or radiologic findings. Urethrocystoscopy is the only way to confirm the diagnosis, but has been subject to criticism as it is associated with a high risk of strictures. It is advisable to adopt a "wait and see" strategy because urethritis posterior usually heals spontaneously over time. This condition is most likely caused by detrusor-sphincter dyssynergia, since behavioural intervention with biofeedback therapy offers good treatment results., (© Georg Thieme Verlag KG Stuttgart · New York.)

For many years an increase in cases of urethritis has been observed in western Europe. In order to be able to combat this continuous rise, the perception of sexually transmitted diseases must be promoted, the clarification and screening must be intensified and therapy must be rapidly and correctly carried out. In addition to the commonest pathogens causing urethritis, namely chlamydia and gonococci, many other pathogenic microbes must be taken into consideration in the diagnostics. With respect to therapy, apart from the increasing resistance formation of Mycoplasma genitalium, the decreasing effectiveness of standard forms of treatment of other microbes must be emphasized. For chronic and recurrent urethritis in particular a broad clarification of the pathogen should be carried out to enable targeted treatment and also partner treatment. Priority must again be given to primary prevention.

The German STI guidelines for gonococcal and chlamydial infections were recently updated. Representing the German Society of Urology (DGU) in these guidelines consensus processes, the authors summarize the recommendations regarding screening, appropriate laboratory diagnostics and dose-increased dual antimicrobial therapy of urethritis caused by Neisseria gonorrhoeae and Chlamydia trachomatis. Urologists need to be informed about an approaching era of untreatable gonorrhea. Although of limited use, whenever possible Neisseria gonorrhoeae cultures are required to monitor developing resistance to current treatment regimes. Recommendations for the use of nucleic acid amplification tests (NAATs) for detection of chlamydia and gonorrhea as the standard laboratory test remain. Because the majority of persons infected by Chlamydia trachomatis are not aware of the infection, untreated infection can lead to serious complications later on with the burden of disease and infertility sequelae considered to be a predominantly female problem. Principally, both partners should be treated simultaneously in order to prevent re-infection. Furthermore, therapy control is recommended for every gonorrhea.

The term male adnexitis summarizes acute and chronic infections of the male urogenital tract. Chronic infections and inflammatory conditions are difficult to diagnose and the therapy has not been standardized. Therapy and management of complications has been clearly defined for acute urogenital infections. To date, antibiotic treatment in chronic infections and inflammatory conditions is only indicated when pathogenic bacteria can be retrieved from urogenital secretions.The usefulness of treatment with anti-inflammatory drugs is still debatable. One of the major concerns is the effect of urogenital infection on the fertility of the male. Although associations between urogenital infections and infertility have been shown for some entities, a general negative outcome of infectious events on male fertility appears to be unlikely.

A 68 year old man presented with urethritis and a purulent discharge, carrying the tentative diagnosis of gonorrhea. He had already been treated with multiple antibiotics. Microbiological investigation revealed Pseudomonas aeruginosa, a relatively frequent Gram-negative bacteria in hospitals, which can cause several nosocomial diseases such as pneumonia, wound infections and urogenital infections. Therapy can be difficult because of frequent antibiotic resistance. Guided by sensitivity studies, the patient was successfully treated with gyrase inhibitors. Pseudomonas aeruginosa-induced urogenital infections in ambulatory patients are extremely rare and usually not associated with a gonorrhea-like discharge.

Urogenital infections may often have a major effect on fertility. For the most part, however, the pathogenetic aspects of such cases have not yet been clarified. In the future, the integration of functional and molecular parameters will be decisive for defining an interaction between urogenital infection and male fertility. As a rule, infection-related alterations to the ejaculate require antimicrobial treatment, although the effect of the latter on fertility remains uncertain.

545 male patients with a tentative diagnosis "urethritis" were examined between November 1984 and December 1994 in the Department of Dermatology and Venerology of the Military Hospital in Ulm. The patients, aged from 18 to 58 years (mean age 24.1 years), were examined according to a standardized diagnostic procedure: Smear preparations from the urethra with subsequent gram staining, bacterial cultures for aerobic bacteria, Neisseria gonorrhoeae (cultures and Phadebact gonococcus test), mycoplasma cultures (Mycoplasma hominis (M. hom.); Ureaplasma urealyticum (U. u), and Chlamydia trachomatis using several methods, primarily DIFT (Syva Micro-Trak). Trichomonas vaginalis counts in urine sediment 441 patients (81%) had 4 or more leukocytes per high-power (x1000) field in the gram stained specimens. In these 441 urethritis-patients the following germs could be detected: Trichomonas vagin 3 (1%), N. gonorrhoeae 80 (18%), Mycoplasma 94 (21%) [U. u. 59, M. hom. 24, both 11], C. trachomatis 114 (26%), other pathogenic bacteria 135 (31%). In 114 patients (26%) no bacteria could be identified. A single infection was diagnosed in a total of 242 patients (55%), a double infection was determined in 71 patients (16%) while a triple infection was found in 14 patients (3%). The spectrum determined in the single infection included the following: N. gonorrhoeae 41 (9%), Mycoplasma 45 (10%), C. trachomatis 67 (15%), other pathogenic bacteria 89 (20%) (most frequently found germs were Enterococcus, beta-hemolytic Streptococcus, Escherichia coli, Staph. aureus). In the double infections combinations with aerobic bacteria dominated. In triple infections, mycoplasma were most common. During the investigation period the number of patients with urethritis symptoms declined at a constant rate.

Objective: Comparison of four different assays for routine diagnosis of urogenital Chlamydia trachomatis infections., Methods: Samples from 285 female patients were tested using each of the following tests: PCR (Amplicor Chlamydia trachomatis), ELFA (VIDAS Chlamydia), cell culture and direct immunofluorescence assay (DFA)., Results: C. trachomatis was detected by PCR in 13 endocervical swab specimens obtained from 189 female patients (6.9%). Among 13 PCR-positive samples, 10 tested positive by cell culture and DFA, and 8 were positive by ELFA. For 3 patients with pregnancy-related complications, a positive result was obtained by PCR only. Each of the 96 urethral swabs proved to be negative., Conclusions: PCR is more sensitive than cell culture, DFA and ELFA, especially in the context of C. trachomatis infection during pregnancy. In addition and in order to avoid false-negative PCR results, a careful collection of epithelial cells infected with C. trachomatis is imperative.

Certain ejaculate infections can be traced back to sexually transmitted microorganisms, such as Neisseria gonorrhoeae, Chlamydia trachomatis, Ureaplasma urealyticum and Trichomonas vaginalis. To varying extents, these microorganisms cause such classical genital infections as urethritis, epididymitis and prostatitis as well as subclinical genital tract infections. Several different pathomechanisms are under discussion for infection of the ejaculate: reduction of spermatogenesis resulting from testicular damage, autoimmune processes induced by inflammation, direct influence on the spermatozoal function, disturbances in spermatozoal transport, secretory dysfunction of the male accessory sex glands and leukocytospermia with secondary influence on ejaculate parameters. The relevance of these microorganisms for the localization of the inflammatory process within the genital tract are discussed in detail. Their importance for male fertility is a matter of debate. In particular, the significance of C. trachomatis and U. urealyticum, both of which are detectable in the urethra, is still uncertain and cannot be assessed conclusively. Further information allowing delimitation of an infection resulting from bacterial colonization may be provided, on the one hand, by biochemical markers for an inflammatory reaction and indicators of an immune response in the ejaculate, e.g. PMN elastase, complement C3, or coeruloplasmin, and on the other hand, by secretion markers such as alpha-glucosidase, PSA and phosphatase. Whether the assessment of these markers and indicators can help to clarify the inflammatory origin of infertility in individual cases remains doubtful.

The history and the results of clinical investigations in 74 patients with and 262 men without urethral Chlamydia (C.) trachomatis infection were evaluated: symptoms such as dysuria, discharge and/or burning/itching in the genital region were reported by 77% (n = 57) of the patients with an infection and 63.4% (n = 166) of the men without an infection. Upon clinical investigation, discharge was found in 55.4% (n = 41) of the chlamydia-positive patients and in 47.7% (n = 125) of the chlamydia-negative men. Only when yellow, whitish yellow and clear discharge were distinguished from one another was the difference between the two groups of patients (56.1% versus 12%) significant. Microscopic signs of urethritis, i.e. significant numbers of polymorphonuclear leukocytes (greater than 4 per high-power field and oil immersion) were detectable in the smears of 59.5% (n = 44) of the chlamydia-positive patients, in contrast to 15.6% (n = 41) in the smears of chlamydia-negative men. Overall, 67.6% (n = 50) of the patients with a C. trachomatis infection reported symptoms in the anamnesis combined with signs of urethritis upon clinical and microscopic investigation. There were 9.5% (n = 7) of the patients who either mentioned symptoms or showed clinical signs, and 13.5% (n = 10) who neither mentioned symptoms nor showed clinical signs. These results indicate that microbiological detection of the infectious agent is obligatory for diagnosis of urethral infection with C. trachomatis.

A total of 56 Chlamydia trachomatis strains isolated from female and male patients in the STD outpatient clinic of the Department of Dermatology, University of Heidelberg, were serotyped by means of monoclonal antibodies in an indirect immunofluorescence test. The most prevalent serovar was serovar E, with 35.7%, followed by serovar D, with 28.6%, and serovar F, with 26.8%. No double or multiple infections with different C. trachomatis serovars were found. The first epidemiological study of C. trachomatis serovars in Germany shows that the distribution of distinct serovars is not essentially different from that found in other western countries. The distribution of serovars was similar in women and men. There was no demonstrable correlation between asymptomatic or symptomatic courses of the infections with distinct serovars. In addition, the presence of polymorphonuclear leucocytes in urethritis or cervicitis was not associated with distinct serovars. These results indicate that the antigens used as a criterion in the classification of C. trachomatis are not correlated with the biological behaviour of this infections agent.

A total of 234 urogenital specimens were investigated with a radioactive and a nonradioactive rRNA:cDNA-hybridization test for the direct detection of Chlamydia trachomatis (Gen-Probe, San Diego, Calif.). The results were compared with those yielded by the conventional cell culture technique (McCoy cells). Using cell culture a urogenital C. trachomatis infection could be detected in 37 of 234 patients (15.8%) at two outpatient sexually transmitted disease clinics. Referred to the detection rate, cell culture sensitivity was 83.8% for the radioactive test and 86.5% for the nonradioactive DNA-hybridization test. The specificity of the radioactive test was 94.8% and that of the nonradioactive test, 93.4%.

Abacterial urethritis and colpitis in man and woman is frequently produced by Ureaplasma urealyticum and Mycoplasma hominis. These agents are transmitted by sexual intercourse and they have to be classified as facultative pathogenic. The clinical value and the therapeutical necessity depend on the clinical picture as well as on an exactly follow up microbiological and immunological diagnosis. As in all sexually transmitted diseases the sex-partner too should be examined and given a corresponding therapy. For general treatment of genital Mycoplasma infections tetracyclines are usually employed, whereas for Ureaplasma infections erythromycin has been very successful too. To prevent reoccurrence treatment should be consequently executed for 14 days up to three weeks.

One of the etiological agents of urethritis and prostatitis is Chlamydia trachomatis which reveals obligatory intracellular parasitism. Patient specimens (smears of the urethra, urine, first portion, expressed prostatic fluid, ejaculate) are centrifuged onto special cell cultures, so-called McCoy cells, and induce characteristic cytoplasmatic inclusions. Giemsa staining or DNA-binding fluorochromes (DAPI or Hoechst 33258) are suitable procedures to identify chlamydia inclusions. Serologic tests to establish infections due to Chlamydia trachomatis are only of limited diagnostic value.

2,213 sera of normal persons and of men with nongonococcal urethritis were tested by CF. 4.5% of the males, 9.2% of the females, and 10.8% of the urethritis-patients had titers of 1 : greater than or equal to 16 when tested against a group-specific chlamydial antigen. The usefullness of the CFT for seroepidemiological studies was confirmed.

Chlamydia trachomatis represents an important infectious agent for sexually transmitted diseases. In the USA more than 3 million new cases are recorded per year. The clinical picture and late complications are similar to those of gonorrhea; however, infections from C. trachomatis have relatively mild symptoms. This group of diseases may therefore be overlooked, and complications and late sequelae due to C. trachomatis thus occur more frequently in comparison to N. gonorrhoeae. From the viewpoint of general health in a population, chlamydial infections seem to be more important than the classic venereal diseases. The number of infections may be underestimated as infected individuals may be asymptomatic and are therefore not diagnosed and the disease recorded. Knowledge about chlamydial infections has increased significantly, and C. trachomatis today can easily be diagnosed by routine laboratory methods; this report deals with current knowledge regarding the epidemiology, clinical symptoms, complications, diagnosis, and treatment of genital chlamydial infections.

The infectious male urethritis is characterized by the urethral discharge, which is clear or purulent due to the number of leucocytes. Infection occurs mostly in sexual intercourse. Neisseria gonorrhoeae today causes only about 20-30% of the infections. Gramnegative bacteria are demonstrable by microscopic examination of the urethral discharge, otherwise by cultivation. Ureaplasma and chlamydia trachomatis, an intracellular growing bacterium, are the most frequent agents in infectious urethritis. They are often found together, the cultivation requires special laboratory conditions. They are common saprophytis bacteria within the urethra (u. urealyticum in up to 50%), their number of colony forming units of urethritis, like yeasts, viruses, trichomonas are rare. The treatment of gonorrhoic urethritis is done by penicillin or spectinomycin. Infections by u. urealyticum and c. trachomatis are treated with tetracyclin. Although spontaneous healing is not uncommon, therapy should be performed with respect to the high risk of following prostatitis and epididymitis.

The diagnosis of sexually transmitted diseases can be exactly defined nowadays, since the specific germs responsible for urethritis have been microbiologically characterized. The term "unspecific urethritis", therefore, should be replaced or completed by the identified specific germ. A short description is given of the various techniques (native procedures, staining, culture, and technical methods like Elisa or immunofluorescence), which can be performed in dermatologic practises. In addition, a survey of the urethritis germs isolated at the Hamburg Department of Dermatology is presented.

In the Reiter syndrome apart from the symptomatology on the part of the urogenital tract, the changes of eyes and joints a series of further diagnostically important participations of organs appear. In most cases is at the beginning an intestinal infection which, after characteristic latency periods, is followed by urethritis, arthritis and changes of the eyes. Characteristic is further an affection of skin and mucous membrane; facultatively a participation of the heart appears. Different types of course render the diagnosis difficult. The investigation for the occurrence of HL-A 27 is useful.

Infectious non-gonococcal urethritis (NGU) is a sexually transmitted disease of considerable importance. The etiologic agents are bacteria, to lesser extent yeasts, parasites (Trichomonas) or viruses. A considerable part of NGU is caused by bacterial groups with peculiar properties: Mycoplasmas, which lack a rigid cell wall, and chlamydiae, which are intracellular parasites. Because of the diversity of etiologic agents and qualified microbiological diagnosis is a prerequisite for a specific and successful therapy.

The multiple etiology of non-gonorrhoic urethritis has been extensively investigated in the last few years. It has thus become possible to diagnose the separate forms and consequently treat them with a greater degree of accuracy and specificity. For exact diagnosis multiple and time consuming examinations are often necessary. Sometimes this can only be done in highly specialized laboratories. Among the agents triggering such an infection Chlamydia (30.9% of the cases of non-gonorrhoic urethritis), as well as mycoplasma, ureaplasma, anaerobic bacteria and herpes simplex viruses have gained particular significance. Whereas these infections very rarely lead to complications by ascension in men they can result in unpleasant and severe disease in women (salpingitis, infertility, newborn infection).

Chlamydia trachomatis represents one of the most common causative agents of sexually transmitted diseases. Clinically, genital chlamydial infections are similar to gonorrhoea. Although the clinical symptoms in chlamydial infections are usually milder than those in gonorrhoea, late complications are more common and more dangerous, because the carriers may easily escape notice. The knowledge of chlamydial infections has increased during the last few years. The present report deals with recent developments in this field.

120 patients with abacterial urethritis were studied for chlamydia. Clinical, cytological, serologic and electronenmicroscopic tests were performed. 66.60% of the tested persons were seropositive for C. trachomatis, 32.50% of all patients and 48.80% of the seropositive patients showed positive cytological tests. Direct electron microscopy of biopsy material of the urethra of 30 patients revealed chlamydial bodies in high concentrations. The incubation period was about 1-2 weeks. Oxytetracycline was used for 8 days, but had to be one- to four times repeated in resistent cases.

In 233 patients suffering from chronic prostatitis, increased granulocyte counts in prostatic secretions revealed real inflammation in 111 patients (47,6%): four patients (1,7%) suffered from specific and 22 (9,4%) from chronic bacterial prostatitis. In 85 men (36,5%) "non-bacterial" prostatitis was evident, whereby in 22 (9,4%) ureaplasma-associated prostatitis was obvious. 26 men (11,2%) showed increased granulocyte counts in prostatic secretions, in these cases the mere microbiological finding was C. trachomatis. In 28 cases (15,9%) concomitant inflammatory urethral reactions were the only clinical finding.