- 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
- Coinfection is also common
- Most common in young, sexually active men
- 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
- 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!
- Confirming urethritis
- Identifying the causative pathogen
- Offer to test for HIV, syphilis, and hepatitis B. 
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!