Urethritis

Urethritis is inflammation of the urethral epithelium. The most common causes are sexually transmitted bacteria—Neisseria gonorrhoeae, Chlamydia trachomatis, and Mycoplasma genitalium—although viruses and fungi can occasionally be responsible. Inflammation explains the usual symptoms: burning with urination, urethral irritation or itching, and discharge. The discharge may be obvious, scant, or absent. Symptoms alone do not identify the organism, and dysuria without discharge is not automatically a urinary tract infection. The patient’s sexual history, exposure pattern, examination, and testing have to be considered together. The urethra may be the first site of infection, but untreated infection can extend upward. Depending on the patient’s anatomy, complications include pelvic inflammatory disease, epididymitis, urethral stricture, and increased risk of HIV transmission. A localized complaint can therefore become a systemic or reproductive-health problem. For an RPN, the clinical task is not to independently name the organism or choose an antimicrobial regimen outside an authorized order or protocol. The task is to recognize the syndrome, obtain accurate information and specimens, administer prescribed treatment safely, identify red flags, reinforce follow-up, and report changes promptly within provincial scope and...