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Die Dermatologie

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17.10.2023 | Urethritis | Leitthema

Urethritis – Erregerspektrum, Diagnostik und Therapie

verfasst von: Dr. Susanne Buder

Erschienen in: Die Dermatologie | Ausgabe 11/2023

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Zusammenfassung

Eine Urethritis kann durch ein breites Spektrum von Bakterien, Pilzen, Protozoen und Viren hervorgerufen werden, wobei insbesondere Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium und Trichomonas vaginalis als klassische Erreger sexuell übertragbarer Infektionen (STI, sexually transmitted infection) im Fokus der diagnostischen Erwägungen stehen. Zur vollständigen Diagnosestellung wird ein stufenweises Vorgehen gewählt. Die Mikroskopie mit Färbepräparat ermöglicht bei symptomatischen Männern eine erste Unterscheidung zwischen gonorrhoischer und nicht-gonorrhoischer Urethritis als POC(Point-of-Care)-Test. Die Diagnostik mittels NAAT (nucleic acid amplification technology) wird zum spezifischen und sensitiven Erregernachweis genutzt und bietet als Multiplexdiagnostik die Möglichkeit zum Nachweis mehrerer Organismen aus derselben Probe. Zudem werden hierbei – im Vergleich zur Kultur – keine vitalen Organismen benötigt, was die Entnahme und Verwendung vielfältigerer und weniger invasiver biologischer Proben (Erststrahlurin beim Mann oder Vaginalabstriche) ermöglicht. Die Empfindlichkeitstestung mittels Kultur bleibt für N. gonorrhoeae bei zunehmender Resistenzentwicklung unerlässlich. Die Therapie einer Urethritis richtet sich nach dem vermuteten oder nachgewiesenen Erreger unter Berücksichtigung der aktuellen Leitlinien. Therapieversagen kann vielfältige Ursachen haben (Koinfektion, mangelnde Therapieadhärenz, Reinfektion oder Resistenz des Erregers) und erfordert ein erneutes diagnostisches und therapeutisches Vorgehen und eine differenzierte Betrachtung.

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Titel: Urethritis – Erregerspektrum, Diagnostik und Therapie
verfasst von: Dr. Susanne Buder
Publikationsdatum: 17.10.2023
Verlag: Springer Medizin
Schlagwörter: Urethritis
Urethritis
Hautkrankheiten der äußeren Genitalien
Neisseria gonorrhoeae
Chlamydia trachomatis
Chlamydia trachomatis
Sexuell übertragbare Erkrankungen
Sexuell übertragbare Erkrankungen
Sexuell übertragbare Erkrankungen
Sexuell übertragbare Erkrankungen
Gonorrhoe
Trichomonas vaginalis
Chlamydien
Erschienen in: Die Dermatologie / Ausgabe 11/2023
Print ISSN: 2731-7005
Elektronische ISSN: 2731-7013
DOI: https://doi.org/10.1007/s00105-023-05230-6

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Bildnachweise

Urethralabstrich, Gram-Färbung, neutrophile Granulozyten/© Susanne Buder / all rights reserved Springer Medizin Verlag GmbH, Die Leitlinien für Ärztinnen und Ärzte, Älterer Patient wird von einer Pflegefachkraft betreut/© karelnoppe / stock.adobe.com (Symbolbild mit Fotomodellen), Frau misst Blutdruck/© Microgen / stock.adobe.com (Symbolbild mit Fotomodell), Tote Biene auf dem Boden/© Delphotostock / stock.adobe.com (Symbolbild), Ärztin misst Blutdruck bei Senior/© Drazen / Stock.adobe.com (Symbolbild mit Fotomodellen)

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