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Urethritis in adult men

Arlene C Seña, MD, MPH
Myron S Cohen, MD
Heidi Swygard, MD, MPH
Section Editor
Noreen A Hynes, MD, MPH, DTM&H
Deputy Editor
Allyson Bloom, MD


Urethritis, or inflammation of the urethra, is a common manifestation of sexually transmitted infections among men.

This topic addresses the clinical manifestations, diagnosis, and empiric treatment of urethritis. Details on the clinical manifestations, diagnosis, and treatment of specific pathogens that can cause urethritis are discussed elsewhere. (See "Epidemiology and pathogenesis of Neisseria gonorrhoeae infection" and "Treatment of uncomplicated gonococcal infections" and "Clinical manifestations and diagnosis of Chlamydia trachomatis infections" and "Treatment of Chlamydia trachomatis infection" and "Mycoplasma genitalium infection in men and women".)


Infectious urethritis is typically caused by a sexually transmitted pathogen, thus most cases are seen in young, sexually active men.

Overall, Neisseria gonorrhoeae and Chlamydia trachomatis are the most common organisms identified in cases of urethritis. Because N. gonorrhoeae is easily visualized on Gram stain, which is classically the primary mode of evaluating urethral discharge in men, urethritis is traditionally classified as gonococcal versus non-gonococcal.

Gonococcal urethritis — N. gonorrhoeae is a common cause of urethritis in the United States and Europe, especially in urban areas and sexually transmitted infection (STI) clinics. In a study of 768 men screened for sexually transmitted infections at 11 different clinic settings in the United States, the prevalence of N. gonorrhoeae ranged from 21.6 percent among symptomatic to 1.4 percent among asymptomatic men [1]. In 2012, the overall incidence of gonorrhea cases among men reported to the United States Centers for Disease Control and Prevention (CDC) was 105.8 per 100,000 men [2]. However, incidence varied substantially by race and geographical region. As examples, gonorrhea rates were disproportionately higher among black non-Hispanic men (462.0 per 100,000) compared with white non-Hispanic men (31.0 per 100,000) and were highest in the South (131.9 cases per 100,000 people) compared with other regions in the country.


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Literature review current through: Jun 2015. | This topic last updated: Oct 31, 2014.
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  1. Taylor SN, Liesenfeld O, Lillis RA, et al. Evaluation of the Roche cobas® CT/NG test for detection of Chlamydia trachomatis and Neisseria gonorrhoeae in male urine. Sex Transm Dis 2012; 39:543.
  2. CDC. National overview of sexually transmitted diseases (STDs), 2012. http://www.cdc.gov/std/stats12/natoverview.htm (Accessed on October 30, 2014).
  3. Black V, Magooa P, Radebe F, et al. The detection of urethritis pathogens among patients with the male urethritis syndrome, genital ulcer syndrome and HIV voluntary counselling and testing clients: should South Africa's syndromic management approach be revised? Sex Transm Infect 2008; 84:254.
  4. Lyss SB, Kamb ML, Peterman TA, et al. Chlamydia trachomatis among patients infected with and treated for Neisseria gonorrhoeae in sexually transmitted disease clinics in the United States. Ann Intern Med 2003; 139:178.
  5. Sexually transmitted disease surveillance, 2011, United States Centers for Disease Control and Prevention, Division of STD prevention. December 2012. http://www.cdc.gov/std/stats11/Surv2011.pdf (Accessed on May 30, 2013).
  6. Burstein GR, Zenilman JM. Nongonococcal urethritis--a new paradigm. Clin Infect Dis 1999; 28 Suppl 1:S66.
  7. Stamm WE. Chlamydia trachomatis infections: progress and problems. J Infect Dis 1999; 179 Suppl 2:S380.
  8. Gaydos C, Maldeis NE, Hardick A, et al. Mycoplasma genitalium compared to chlamydia, gonorrhoea and trichomonas as an aetiological agent of urethritis in men attending STD clinics. Sex Transm Infect 2009; 85:438.
  9. Stamm WE, Hicks CB, Martin DH, et al. Azithromycin for empirical treatment of the nongonococcal urethritis syndrome in men. A randomized double-blind study. JAMA 1995; 274:545.
  10. Bradshaw CS, Tabrizi SN, Read TR, et al. Etiologies of nongonococcal urethritis: bacteria, viruses, and the association with orogenital exposure. J Infect Dis 2006; 193:336.
  11. Romanowski B, Talbot H, Stadnyk M, et al. Minocycline compared with doxycycline in the treatment of nongonococcal urethritis and mucopurulent cervicitis. Ann Intern Med 1993; 119:16.
  12. Schwebke JR, Rompalo A, Taylor S, et al. Re-evaluating the treatment of nongonococcal urethritis: emphasizing emerging pathogens--a randomized clinical trial. Clin Infect Dis 2011; 52:163.
  13. Watson-Jones D, Mugeye K, Mayaud P, et al. High prevalence of trichomoniasis in rural men in Mwanza, Tanzania: results from a population based study. Sex Transm Infect 2000; 76:355.
  14. Hobbs MM, Kazembe P, Reed AW, et al. Trichomonas vaginalis as a cause of urethritis in Malawian men. Sex Transm Dis 1999; 26:381.
  15. Price MA, Miller WC, Kaydos-Daniels SC, et al. Trichomoniasis in men and HIV infection: data from 2 outpatient clinics at Lilongwe Central Hospital, Malawi. J Infect Dis 2004; 190:1448.
  16. Handsfield HH. Nongonococcal urethritis: a few answers but mostly questions. J Infect Dis 2006; 193:333.
  17. Katz AR, Chasnoff R, Komeya A, Lee MV. Neisseria meningitidis urethritis: a case report highlighting clinical similarities to and epidemiological differences from gonococcal urethritis. Sex Transm Dis 2011; 38:439.
  18. Yokoi S, Maeda S, Kubota Y, et al. The role of Mycoplasma genitalium and Ureaplasma urealyticum biovar 2 in postgonococcal urethritis. Clin Infect Dis 2007; 45:866.
  19. Couldwell DL, Gidding HF, Freedman EV, et al. Ureaplasma urealyticum is significantly associated with non-gonococcal urethritis in heterosexual Sydney men. Int J STD AIDS 2010; 21:337.
  20. Ondondo RO, Whittington WL, Astete SG, Totten PA. Differential association of ureaplasma species with non-gonococcal urethritis in heterosexual men. Sex Transm Infect 2010; 86:271.
  21. Totten PA, Schwartz MA, Sjöström KE, et al. Association of Mycoplasma genitalium with nongonococcal urethritis in heterosexual men. J Infect Dis 2001; 183:269.
  22. William M. McCormack. Urethritis. In: Mandell, Douglas, and Bennett's Principles and Practice of Infectious Disease, 7, Gerald L Mandell, John E. Bennet, and Raphael Dolin. (Eds), Elsevier, 2010. Vol I, p.1485.
  23. Schofield CB. Some factors affecting the incubation period and duration of symptoms of urethritis in men. Br J Vener Dis 1982; 58:184.
  24. McNagny SE, Parker RM, Zenilman JM, Lewis JS. Urinary leukocyte esterase test: a screening method for the detection of asymptomatic chlamydial and gonococcal infections in men. J Infect Dis 1992; 165:573.
  25. Kent CK, Chaw JK, Wong W, et al. Prevalence of rectal, urethral, and pharyngeal chlamydia and gonorrhea detected in 2 clinical settings among men who have sex with men: San Francisco, California, 2003. Clin Infect Dis 2005; 41:67.
  26. http://www.cdc.gov/std/treatment/2010/default.htm (Accessed on October 16, 2014).
  27. Orellana MA, Gómez-Lus ML, Lora D. Sensitivity of Gram stain in the diagnosis of urethritis in men. Sex Transm Infect 2012; 88:284.
  28. Mathew T, O'Mahony C, Mallinson H. Shortening the voiding interval for men having chlamydia nucleic acid amplification tests. Int J STD AIDS 2009; 20:752.
  29. Kwan B, Ryder N, Knight V, et al. Sensitivity of 20-minute voiding intervals in men testing for Chlamydia trachomatis. Sex Transm Dis 2012; 39:405.
  30. Bachmann LH, Hobbs MM, Seña AC, et al. Trichomonas vaginalis genital infections: progress and challenges. Clin Infect Dis 2011; 53 Suppl 3:S160.
  31. Mena LA, Mroczkowski TF, Nsuami M, Martin DH. A randomized comparison of azithromycin and doxycycline for the treatment of Mycoplasma genitalium-positive urethritis in men. Clin Infect Dis 2009; 48:1649.
  32. Manhart LE, Gillespie CW, Lowens MS, et al. Standard treatment regimens for nongonococcal urethritis have similar but declining cure rates: a randomized controlled trial. Clin Infect Dis 2013; 56:934.
  33. Seña AC, Lensing S, Rompalo A, et al. Chlamydia trachomatis, Mycoplasma genitalium, and Trichomonas vaginalis infections in men with nongonococcal urethritis: predictors and persistence after therapy. J Infect Dis 2012; 206:357.
  34. Fung M, Scott KC, Kent CK, Klausner JD. Chlamydial and gonococcal reinfection among men: a systematic review of data to evaluate the need for retesting. Sex Transm Infect 2007; 83:304.