Infections in Pregnancy: Acute Urethritis

Infections in Pregnancy: Acute Urethritis

What Is Acute Urethritis?

Acute urethritis involves inflammation and infection of the urethra, the canal through which urine flows from the bladder out of the body. It is usually caused by one of three bacteria: E coli, Neisseria gonorrhoeae (gonorrhea), or Chlamydia trachomatis (chlamydia). E. coli, one of many bacteria normally present in the rectum and vagina, may be introduced into the urethra during intercourse or when wiping after a bowel movement. The gonorrhea and chlamydia bacteria are transmitted by sexual contact with an infected partner.

What Are the Consequences of Acute Urethritis?

When gonorrhea and chlamydia are found in a woman's urethra, they are usually present in the cervix as well. In non-pregnant patients, these microorganisms may cause upper-genital tract infection (pelvic inflammatory disease or PID) if not treated promptly. Infections with these bacteria during pregnancy may increase the risk of preterm delivery-the most common cause of death and non-fatal complications in newborn babies.

Urethritis caused by E. coli or other similar organisms (Klebsiella and Proteus) can ascend into the bladder and kidneys. Infection of the kidneys (pyelonephritis) in pregnancy may lead to preterm labor and other complications.

In addition, when delivered through an infected birth canal, a baby may develop a serious eye infection (caused by gonorrhea or chlamydia) or respiratory tract infection (due to chlamydia).

How Is Acute Urethritis Diagnosed?

Patients with acute urethritis typically have the following urinary symptoms:

  • frequency (the need to urinate often);
  • urgency (the need to urinate immediately);
  • hesitancy (delay in starting the stream of urine);
  • dribbling; or
  • painful urination, known as dysuria.

When gonorrhea or chlamydia bacteria cause the infection, a yellow, pus-like discharge from the urethra may be present.

To confirm the diagnosis, your doctor may examine a sample of your urine for the presence of high numbers of white blood cells. By culturing a sample of the discharge from your urethra, your doctor can diagnose gonorrhea. The most useful test for identifying chlamydia in the urethral discharge is through a DNA probe.

How Should Acute Urethritis Be Treated?

If E. coli is the suspected cause of infection, you will be treated with trimethoprim-sulfamethoxazole double strength (Septra DS, Bactrim DS) twice daily for three days or nitrofurantoin monohydrate macrocrystals (Macrobid) twice daily.

If gonorrhea and/or chlamydia is the suspected cause of infection, the most cost-effective treatment is a single, oral dose of cefixime (Suprax) or injection of ceftriaxone (Rocephin) for gonorrhea, plus a single oral dose of azithromycin (Zithromax) for chlamydia.

If you are pregnant and have a penicillin allergy, you will be given a single injection of spectinomycin (Trobicin) for gonorrhea. If you are not pregnant but are allergic to penicillin or cephalosporin antibiotics, you may be treated for gonorrhea with a seven-day course of doxycycline (Vibramycin) or a single dose of quinolone antibiotics, such as ciprofloxacin (Cipro) or ofloxacin (Floxin). Penicillin-allergic patients can still be given azithromycin to treat chlamydia. Your sexual partner must be treated as well, according to the guidelines just described.

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