Gonococcal urethritis

Last revised by Mohammad Taghi Niknejad on 27 Nov 2023

Gonococcal urethritis is an infection of the urethra caused by Neisseria Gonorrhoeae, a gram-negative diplococcus. It is the most common sexually transmitted disease in adults 1.

Patients usually present with purulent urethral discharge in acute infection. Diagnosis is usually made by clinical and laboratory findings. When complicated by urethral strictures, patients will present with obstructive symptoms 1.

Gonococcal urethritis is more common than non-gonococcal urethritis. About 15% of men with gonococcal urethritis will develop urethral strictures after 2-30 years of infection.

Imaging is usually done to diagnose complications like urethral stricture, periurethral abscess, and periurethral fistula 1. Uncomplicated urethritis usually doesn't require imaging studies.

Retrograde urethrography and voiding cystourethrography are the modalities of choice for urethral imaging. Other imaging modalities are used for periurethral lesions.

Gonococcal urethritis can lead to fibrous scarring of anterior urethra, resulting in long irregular urethral narrowing several centimeters long, commonly in the bulbous urethra, especially the distal part. The stricture extends to membranous urethra in more than 90% of cases 2.

The infection is also associated with dilatation of urethral glands of Littré. Obstruction of these glands may lead to a serious complication, a periurethral abscess. Urethral communication to periurethral abscess leads to pseudodiverticulum formation 1.

If the infection results in a urethral stricture, urethroscopic or open surgical interventions are usually required to alleviate obstructive symptoms.

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