Urethritis in adult men
- Arlene C Seña, MD, MPH
Arlene C Seña, MD, MPH
- Associate Professor of Medicine
- University of North Carolina at Chapel Hill
- Myron S Cohen, MD
Myron S Cohen, MD
- Professor of Medicine, Microbiology, Immunology and Public Health
- University of North Carolina at Chapel Hill
- Heidi Swygard, MD, MPH
Heidi Swygard, MD, MPH
- Associate Clinical Professor of Medicine
- University of North Carolina at Chapel Hill
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".)
EPIDEMIOLOGY AND MICROBIOLOGY
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 . 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 . 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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- EPIDEMIOLOGY AND MICROBIOLOGY
- Gonococcal urethritis
- Nongonococcal urethritis
- CLINICAL MANIFESTATIONS
- Gram stain of urethral sample
- First catch urine
- ADDITIONAL EVALUATION
- Determining the microbial etiology
- Evaluation for complications and other sites of infection
- Screening for other sexually transmitted infections
- DIFFERENTIAL DIAGNOSIS
- Initial therapy
- - Gonococcal urethritis
- - Non-gonococcal urethritis
- - Directed therapy
- Recurrent or persistent symptoms
- FOLLOW UP
- Test of cure
- Repeat testing
- PARTNER MANAGEMENT
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS