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Urethritis

Last updated: February 12, 2020

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Urethritis is an inflammation of the urethral mucosa that may be caused by various pathogens, most notably C. trachomatis, N. gonorrhea, and M. genitalium. Transmission primarily occurs as a result of unprotected sexual intercourse and it is especially prevalent in young, sexually active men. Patients typically present with urethral discharge, dysuria, and/or itching of the urinary meatus, although asymptomatic infections are common. Diagnostics include urine dipstick (pyuria, positive leukocyte esterase), staining of a urethral sample, and nucleic acid amplification testing of first-void urine. In gonococcal urethritis, Gram staining of the urethral swab demonstrates gram-negative diplococci and patients are treated with ceftriaxone and azithromycin; otherwise patients are treated with azithromycin or doxycycline for nongonococcal urethritis. Evaluation and treatment of all recent sexual partners is necessary to prevent recurrent infections.

References:[1][2][3][4][5][6][7]

  • Dysuria
  • Burning or itching of the urethral meatus
  • Urethral discharge: purulent , cloudy, blood-tinged, or clear
  • Initial hematuria
  • General symptoms (e.g., fever, chills, or myalgia) are uncommon in urethritis and should raise suspicion for complications (see “Complications” below).

Urethritis, especially nongonococcal urethritis, may also be asymptomatic!
References:[2][5][8]

Dysuria with urethral discharge and no organism on Gram staining of a urethral specimen suggest urethritis by C. trachomatis or M. genitalium!
References:[2][10]

Because coinfection with other genitourinary tract infections is possible, the presence of one infection does not rule out urethritis.

The differential diagnoses listed here are not exhaustive.

  • The initial therapy is usually empiric and, according to prior distinction based on microscopic urethral specimen evaluation, divided into either a GU or NGU regimen.
  • Patients should refrain from sexual activity for 1 week after initiation of therapy.
  • All sexual partners from the 2 months prior to diagnosis should be notified, evaluated for urethritis, and offered empiric treatment.
  • Repeat NAAT 3–6 months after completion of therapy.

Sexual partners should be treated simultaneously to avoid reinfection!
References:[1][2][10]


References:[2][5]

We list the most important complications. The selection is not exhaustive.

  1. Moi H, Blee K, Horner PJ. Management of non-gonococcal urethritis. BMC Infect Dis. 2015; 15 : p.294. doi: 10.1186/s12879-015-1043-4 . | Open in Read by QxMD
  2. Seña AC, Cohen MS, Swygard H. Urethritis in adult men. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/urethritis-in-adult-men.Last updated: October 24, 2016. Accessed: March 29, 2017.
  3. Schwartz MA, Lafferty WE, Hughes JP, Handsfield HH. Risk factors for urethritis in heterosexual men: The role of fellatio and other sexual practices. Sex Transm Dis. 1997; 24 (8): p.449-455.
  4. Urethritis. http://www.antimicrobe.org/e14.asp. Updated: March 29, 2017. Accessed: March 29, 2017.
  5. Terris MK. Urethritis. Urethritis. New York, NY: WebMD. http://emedicine.medscape.com/article/438091. Updated: September 8, 2016. Accessed: March 29, 2017.
  6. Gaydos C, Maldeis NE, Hardick A, Hardick J, Quinn TC. Mycoplasma genitalium compared to chlamydia, gonorrhoea and trichomonas as an aetiological agent of urethritis in men attending STD clinics. Sex Transm Infect. 2009; 85 (6): p.438-440. doi: 10.1136/sti.2008.035477 . | Open in Read by QxMD
  7. Sexually Transmitted Diseases in the United States, 2008. https://www.cdc.gov/std/stats08/trends.htm. Updated: November 16, 2009. Accessed: March 29, 2017.
  8. Kasper DL, Fauci AS, Hauser SL, Longo DL, Lameson JL, Loscalzo J. Harrison's Principles of Internal Medicine. McGraw-Hill Education ; 2015
  9. Brill JR. Diagnosis and Treatment of Urethritis in Men. Am Fam Physician. 2010; 81 (7): p.873-878.
  10. 2015 Sexually Transmitted Diseases Treatment Guidelines: Diseases Characterized by Urethritis and Cervicitis. https://www.cdc.gov/std/tg2015/urethritis-and-cervicitis.htm. Updated: June 4, 2015. Accessed: March 29, 2017.