- Clinical science
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.
- Typically a sexually-transmitted infection
- Noninfectious etiologies: repeated urethral manipulation or chemical irritation
- Coinfection is also common
- Most common in young, sexually active men
- Risk factors
- Unprotected sexual intercourse
- Multiple sexual partners
- History of other sexually transmitted infections
- Burning or itching of the urethral meatus
- Urethral discharge: purulent , cloudy, blood-tinged, or clear
- Initial hematuria
- Systemic findings such as fever, chills, or myalgia are absent in urethritis.
Urethritis, especially nongonococcal urethritis, may also be asymptomatic!
- Confirming urethritis
- Identifying the causative pathogen
Dysuria with urethral discharge and no organism on Gram staining of a urethral specimen suggest urethritis by C. trachomatis or M. genitalium!
Because coinfection with other genitourinary tract infections is possible, the presence of one does not rule out urethritis.
- Acute cystitis
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!