Chronic Urethritis
Chronic inflammation of the urethra is called chronic urethritis, which may be further classified as chronic nongonococcal urethritis (NGU) when gonococcal infection is excluded, or chronic prostatitis/chronic pelvic pain syndrome when symptoms persist beyond 3 months with evidence of urethral inflammation but no identifiable pathogens. 1
Terminology and Classification
The medical literature uses several overlapping terms to describe chronic urethral inflammation:
- Chronic urethritis is the general term for persistent urethral inflammation lasting weeks to months 2, 3
- Chronic nongonococcal urethritis (chronic NGU) specifically refers to chronic inflammation not caused by Neisseria gonorrhoeae 1, 3
- Chronic prostatitis/chronic pelvic pain syndrome is the diagnosis when pain, discomfort, and irritative voiding symptoms persist beyond 3 months, as approximately 50% of men with this syndrome have evidence of urethral inflammation without identifiable microbial pathogens 1
- Chronic posterior urethritis is a specific term used in females to describe inflammation of the bladder neck and proximal urethra, often misdiagnosed as overactive bladder or interstitial cystitis 4
Clinical Context and Diagnostic Considerations
When urethritis becomes chronic (symptoms averaging 12.1 months in one study), the diagnostic approach shifts:
- Objective signs of urethritis must be documented before initiating or continuing antimicrobial therapy, including mucopurulent discharge, ≥5 polymorphonuclear leukocytes per oil immersion field on urethral smear, or ≥10 white blood cells per high-power field on first-void urine 1
- Structural abnormalities occur in 25% of chronic cases, with clinically significant lesions (urethral strictures, benign prostatic hypertrophy) found in 11% of patients 5
- Physical examination and uroflow testing can screen for structural abnormalities that merit endoscopic evaluation in chronic cases 5
Important Clinical Pitfalls
The CDC guidelines emphasize that symptoms alone without objective signs of urethral inflammation are not a sufficient basis for retreatment 1. This is a critical distinction in chronic cases where patients may have persistent discomfort but no active inflammation.
In females, chronic posterior urethritis is frequently underestimated and misdiagnosed as other conditions, with characteristic cystoscopic findings including tuft-like, pseudopodia-like, finger-like, and follicular-like polyps and villi 4.