الحلقة 4 : من حلقات المسكوت عنهم – د/ محمد راضى- Urethral discharge

التعريف

Urethral discharge may be physiological that is not associated with urethritis or it may be pathological discharge due to the presence of urethritis (inflammation of the urethra).

:وتنقسم الى نوعين

 

1- Physiological Discharge: اسباب طبيعيه

* Prosemen *Prostatorrhoea * Precoital Excitation في السيدات

* Premenstrual discharge pregnancy and other hormonal changes في السيدات

2- Pathologic Discharge: اسباب ممرضه

a- Gonococcal Urethritis الاصابه بالسيلان(جرثومي

b. Non-gonococcal Urethritis: that is caused by causes other than gonococci. This is further classified as follows:

1. Traumatic urethritis

– Physical trauma: this is common to occur in patient with sexually transmitted diseases who have severe anxiety so they manipulate the urethra repeatedly to examine for remnants of discharge. This leads to abrasions and irritation of the urethra.اسباب نفسيه ما بعد العلاقه الجنسيه

– Chemical trauma: this is common to occur in patients with sexually transmitted diseases who has severe anxiety so they irritate the urethra repeatedly with antiseptic solution. This leads to irritation of the urethra.استخدام مطهرات موضعيه

2. Infectious urethritis: اصابه في الجهاز البولي بكتريه او فيروسيه او فطريه

– Bacteria: mainly Chlamydia and mycoplasma امثله

– Viruses: as an intraurethral herpes progenitalis and warts. امثله

– Protozoa: trichomonas vaginalis specially if urethritis is of long duration and did not respond to antibiotics

– Fungus: candidiasis.

سرطانات او تقرحات المثانه

3. Neoplastic: Carcinoma of the urethra or the penis may present by the ulcer form or by the stricture formation. Both forms may lead to necrosis and secondary infection of the urethra producing purulent discharge that is resistant to treatment. Accordingly any old male presenting with recent onset of urethral discharge that did not respond to treatment for 2 weeks should be investigated for carcinoma of urethra specially in the uncircumcised men with blood tinged discharge.

التشخيص المعملي

Laboratory Investigations:

A. Diagnosis of the inflammation of the urethra: الرؤيه بالعين

a. Urethral smear: urethritis is diagnosed when there is more than 5 – شريحه من الصديد polymorphonuclear leukocytes (PMNs) per high power field (X1000) in the gram – stained smear.

b. Urine Test: عمل تحليل للبول

 

2. Leukocytes Esterase Test (LET): this test depends on the detection of the esterase enzyme that is released from degenerated leukocytes in the urine. However, it has low sensitivity in the diagnosis of urethritis and is indicated mainly as it is a simple office test to diagnose asymptomatic contacts who refused urethral swabbing.

مزرعه للافرازات وصبغه الجرام

B. Diagnosis of the Infectious Agent in the Urethra:

a. Gram-stained urethral smear: this can diagnose gonococcal infection of the urethra by finding the intracellular and extracellular gram negative dipococci.

b. Culture and other diagnostic tests: In cases that proved to be negative for gonococci in the presence of evidence of urethritis (inflammation of the urethra) the condition is termed as non-gonococcal urethritis. Cultures and other diagnostic tests for other possible organisms should be done for proper treatment of urethritisas the test for Chlamydia, mycoplasma herpes. Trichomonas, candida, etc.

مدة الاصابه مهمه في التشخيص بين النوع الجرثومي والغير جرثومي

الجرثومي 2-7 ايام

الغير جرثومي من 7-21 يوم

Diagnosis of the Inflammation of the Cervix:في السيدات

a. Cervical smear: Endocervical gram – stained smear showing more than 20 PMNs per high power field (1000X) is indicative of cervicitis.

b. Swab Test: endocervical swab showing the yellow colour of the mucopurulent exudates from the endocervix is indicative of cervicitis. This mucus mixed with pus indicates endocervical origin as the vagina contains no mucous glands. This is termed as “positive swab test”.

 

بعض الصور التوضيحيه للفروقات بين 3 انواع عند فحص الشرائح للافرازات

شريحه توضح حاله وجود سيلان

شريحه توضح الحاله الغير جرثوميه

شريحه توضح الاصابه بالكلاميديا وترى الخلايا المصبوغه بصبغة جرام

 

 

 

تحياتي

د\محمد راضي

اخصائي التحاليل الطبيه

 

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