Urethritis is inflammation (mostly due to infection by pathogenic microorganisms) of urethra, which is a common health problem among sexually active adults.

What are the symptoms of urethritis in men?

The common symptoms of Urethritis in men are discharge through urethra and dysuria (pain during urination/micturation) or both symptoms may be present in one person. Frequency of urination generally does not increase in case of Urethritis in men.

Causes of Urethritis in men:

The commonest cause of Urethritis in men is infection by Neisseria gonorrheae. Other causative agents include Chlamydia trachomatis, Mycoplasma genitalium, Ureaplasma urealyticum, Trichomonas vaginalis, HSV (herpes simplex virus). Sometimes adenovirus can also cause Urethritis. These are called non-gonococcal Urethritis (NGU). Coliform bacteria (such as E. coli) can cause urethritis in men if they practice insertive anal intercourse (with men or women).

The non-cholera vibrios do not cause cholera and include V. parahaemolyticus, Non-O1 V. cholerae, V. vulnificus, V. alginolyticus etc.

Mode of transmission of non-cholera vibrios:

The mode of transmission of non-cholera vibrios is usually by ingestion of seawater of ingestion of undercooked shellfish infested with non-cholera vibrios, because non-cholera vibrios can reach high concentrations in the tissues of shellfish.

Symptoms of non-cholera vibrios infection:

There are two major types of syndromes gastrointestinal illness and soft tissue infections. Very rarely V. vulnificus can lead to sepsis in immune compromised individuals.

BPH or Benign Prostatic Hyperplasia is a common health problem among males of more than 55 years of age. Benign changes (as well as malignant) in the prostate increase with age especially after the age of 55 years. Routine autopsies done in the eighth decade of life shows hyperplastic changes in prostate gland in more than 90% of men and malignant changes seen in more than 70% in prostate gland of men.

Anatomy of prostate gland:

To understand the symptoms of BPH, it is important to understand the anatomy and pathology of prostate gland.

Symptoms of BPH:

The symptoms of BPH are mainly of urinary symptoms and include hesitancy in urination, intermittent voiding of urine, a diminished urine stream, incomplete emptying of urine, and postvoid leakage of urine. It should be kept in mind that the severity of symptoms does not always depend on the size of prostate gland (i.e. bigger size does not always mean more sever symptoms). Resistance to urine flow generally reduces bladder compliance and lead to urgency, nocturia (passing of urine during sleep at night), and ultimately urinary retention. Infection, tranquilizing drugs, antihistamines, and alcohol may also precipitate urinary retention. BPH does not produce pain and pain is generally indicative of prostatitis.

Bulimia nervosa (BN) is an eating disorder where there are severe disturbances of eating behavior. The characteristic feature of bulimia nervosa is episodes (which are recurrent) of binge eating that is followed by abnormal compensatory behaviors, such as vomiting (self-induce). Bulimia nervosa characteristically occurs among previously healthy young women who suddenly becomes over conscious about their figure and body weight. Many bulimia nervosa have history of anorexia nervosa. Although bulimia nervosa and anorexia nervosa seems to be in opposite poles, but actually they share many common features and the main differentiating feature of these two (bulimia nervosa and anorexia nervosa) disorders is body weight.

How common is bulimia nervosa?

Clinical bulimia nervosa or true bulimia nervosa has a lifetime prevalence of approximately 1-3%, but occasional binge eating disorder is much more common (5–10%) among young women. Bulimia nervosa is a disease of developed industrialized countries and rare among underdeveloped and poor countries.

Gonococcal arthritis or DGI (Disseminated gonococcal infection) occurs due to presence of gonococcus in blood which disseminate in most part of the body. At present the incidence of gonococcal arthritis or DGI is rare, which may be due to decline in the prevalence of strain responsible for dissemination. The strains responsible for dissemination have capability to resist bactericidal (killing of bacteria) action of human serum and also do not initiate inflammation at genital sites (may be due to production of low level of chemotactic factors). DGI was more common in 1970s and the strain responsible was the PorB.1A serotype, which was more susceptible to penicillin and needed special growth requirements for growth, which mad it difficult to isolate the organism.

Ophthalmia neonatorum is the most common form of gonococcal infection in neonates (first 7 days of life is called neonatal life). The gonococcal infection (ophthalmia neonatorum) in neonates occurs due to exposure to infected cervical secretions during delivery.

Clinical manifestations of gonococcal infection in neonates:

The clinical manifestations of ophthalmia neonatorum are generally acute and begin 2-5 days after birth. Generally ophthalmia neonatorum starts as nonspecific conjunctivitis which manifests as serosanguineous discharge, edema of both the eyelids, chemosis, and a profuse, thick, purulent discharge. If left untreated ophthalmia neonatorum may lead to anterior synechiae, anterior staphyloma, panophthalmitis, and blindness due to corneal ulceration and corneal perforation.

Gonococcal infection (gonorrhea) during pregnancy can have serious consequences for the mother as well as the infant. It is therefore of vital importance to recognize and diagnose gonorrhea in early pregnancy (or as early as possible) to prevent serious consequences of gonorrhea during pregnancy. Early recognition of gonorrhea during pregnancy also helps in identifying women at risk of other STIs (Sexually Transmitted Infections) such as syphilis and trachoma and also helps in instituting therapy promptly. Diagnosis of gonorrhea in early pregnancy (first trimester) is important because the rate of fetal death is high in salpingitis and PID (Pelvic Inflammatory Disease) which may occur due to gonococcal infection.

Due to altered sexual practice during pregnancy (more practice of oral sex), the rate of pharyngeal gonorrhea is high among pregnant women, in compare to general women population. As most cases of pharyngeal gonorrhea are asymptomatic an attempt should be made to identify gonococcal infection of pharynx during pregnancy, so that appropriate therapy can be instituted at right time.

There is definite association between gonorrhea and HIV infection as proved by several well controlled clinical trials on the possible association between presence of gonorrhea and increased HIV infection in Kenya and Republic of Congo (formerly Zaire) in Africa. STIs (Sexually Transmitted Infections) even without causing any ulceration, such as gonorrhea increase the risk of transmission of HIV, probably by increased shedding of virus (HIV) by persons with urethritis or cervicitis (both are symptoms of genital gonorrhea).

Studies done using PCR (polymerase chain reaction) has shown that the HIV-positive men with gonococcal urethritis shed more viruses (HIV) in the ejaculations than men with non gonococcal urethritis. After appropriate treatment of gonococcal urethritis the PCR shows reduction in HIV detection in ejaculations HIV-positive men.

Presence of Neisseria gonorrhoeae (the causative agent of gonorrhea) in rectum and anal canal can occur in females as female anatomy is such that it allows exudates from cervix to spread to rectum and sometimes N. gonorrhoeae can be recovered from rectum in women suffering from uncomplicated gonorrhea (cervicitis).

Isolation of Neisseria gonorrhoeae only in rectum is seen in approximately 5% of women with gonorrhea. Gonococcal infection only in rectum in women is generally asymptomatic, although sometimes may produce symptoms such as rectal pain, purulent discharge from rectum, bleeding from rectum, itching, spasm of rectum etc.

Anorectal gonorrhea is also seen among homosexual men, especially the receptive partner. The incidence of gonococcal infection (including anorectal gonorrhea) among homosexual men came down in 1980s (by more than 90%), but after 1990s there was a resurgence of gonorrhea including anorectal gonorrhea.

Cholera is an acute diarrheal disease. Cholera can cause profound, rapidly progressive dehydration and death within matter of hours. That is the reason cholera (especially cholera gravis or severe form of cholera) was and still is a dreaded disease, especially during epidemics. Fortunately prompt and aggressive fluid replacement along with supportive care can greatly reduce mortality from cholera.

What is the causative agent of cholera?

The causative agent of cholera is Vibrio Cholerae. At present approximately 200 serogroups of V. cholerae are recognized and those are divided into two groups (1) those that agglutinate in antisera to the O1 group antigen (V. cholerae O1) and those that do not (non-O1 V. cholerae). There are two biotypes of V. cholerae, V. cholerae O1, classical and El Tor and each biotype are again subdivided into two serotypes, which are termed Inaba and Ogawa.