Can be classified into gonococcal urethritis and non-gonococcal urethritis (NGU).
Causative organisms:
- Neisseria gonorrhoea
- Chlamydia trachomatis
- Mycoplasma genitalium
- HSV
- Adenovirus
- Trichomonas vaginalis
Ureaplasma is controversial as to whether it is actually pathogenic.
Consider Reiter syndrome (reactive arthritis).
Very common to not find an underlying causative culture.
Clinical presentation
Typically presents with dysuria, urethral pruritus, and urethral discharge.
Work-up:
History – sexual history, duration of symptoms, other STIs, urinary symptoms/risk factors for UTI, systemic symptoms (arthralgia, conjunctivitis)
Examination – look for urethral discharge, other stigmata of STIs (HSV etc). Inguinal lymphadenopathy may be more suggestive of HSV.
First pass urine culture for NAAT for c.trachomatis, n.gonorrhoea, m.genitalium
- Further testing for adenovirus, HSV and trichomonas can be requested for first pass urine.
- M.genitalium may be resistant and require fluoroquinolones.
Urethral swab if discharge present.
Treatment:
Empiric: ceftriaxone 500 mg IM / 1g IV plus 1g azithromycin, plus 100 mg doxycycline BD for 7 days.
Consider testing for other STIs, contact tracing.
Urethroscopy generally unhelpful but can be considered, and especially if haematuria