Urethritis

The thesis is divided into four parts. A. "Balanitis". This part contains cases of "Balanitis" in which urethritis was a prominent symptom. One hundred and ninety-eight cases were investigated. In only 13 cases was urethritis severe enough to warrant the diagnosis of "balano-urethritis". This part also contains all those cases described in the Appendix under the heading "Miscellaneae", complicated in varying degree by urethritis. Some cases were of venereal origin, several not. Several cases were actually dermatoses. It has been clearly shown that only rarely do cases require special treatment and subsequent observations after clinical cure and test of cure. The 13 cases of "balano-urethritis" fall into this category. Treatment consists of one or more of the following:- irrigations; sulphonamides; antibiotics; urological, radiological or surgical interventions. This part emphasizes one important point, namely that many cases of urethritis are secondary to a large group of diseases which may be venereal or non-venereal. The diagnosis of non-specific urethritis of unknown origin would be made less frequently if a full investigation were made to exclude these diseases, which are often the primary cause of the urethritis. B. "Gonorrhoea mixed with other organisms", Thirty-seven cases were investigated between 1953 and 1957. The commonest combinations of mixed infections were Gonococci with l) Diphtheroids, 2) Staphylococci and 3) Coliform bacteria. Combined chemotherapy (sulphonamide-antibiotic) in mixed infections is described and the indications for this therapy and the prevention of acquired drug-resistance. In all cases of mixed gonorrhoea cultures and sensitivity tests are obligator, because microscopical examination of smears is insufficient. The selection and administration of therapeutic agents should only be decided after culture and sensitivity tests have been performed. In mixed infections all the infecting organisms should be regarded as of equal importance. Treatment consists of penicillin together with any other appropriate antibiotic or sulphonamide. These cases require longer observation after final test of cure than simple Gonorrhoea. They should be periodically examined subsequently, especially, if there had been prostatic involvement. C. "Bacterial Non-Gonococcal Urethritis" (B.N.G.U.). One hundred and seven patients and 43 controls were investigated. The incidence of venereal B.N.G.U. in my experience is much higher than that of the non-bacterial venereal condition. It is approximately twice as frequent. This is the reverse of what other workers have found in other areas. Each case must be carefully investigated to establish the correct diagnosis, which in many instances is much more difficult, than simple gonorrhoea. Examination of several smeary cultures, and sensitivity tests are obligatory. Before taking specimens, careful cleansing of the meatus is essential. Prostatic investigation is very important, and valuable especially in cases, with recurrent urethritis and cases of previous gonococcal infection. In time B.N.G.U. treatment is indicated as a rule. Some cases may have to be treated before cultures are available (e.g. sailors). In most cases treatment should be withheld until the results of cultures and sensitivity tests are to hand. The general principles of treatment, observation and tests of cure are as stringent as for gonorrhoea. Patients should be warned about the consequence of failure to observe these principles. D. "Abacterial Urethritis" (A.U.). No bacteria are found in the exudate either on direct examination or by culture. In my experience this is a relatively rare disease. Treatment is very difficult. Complications are much more frequent than in B.N.G.U. or in gonorrhoea. The chief complications are epididymitis and prostatitis. The latter usually recurs in a asymptomatic form. In addition recurrences are common in A.U. Therefore, this type of urethritis must be carefully and conscientiously investigated and thoroughly treated. (Abstract shortened by ProQuest.)