Urethritis: Rapid Evidence Review

 

Am Fam Physician. 2021 May 1;103(9):553-558.

  Patient information: See related handout on urethritis, written by the authors of this article.

Author disclosure: No relevant financial affiliations.

Urethritis refers to inflammation of the urethra and is classified as gonococcal (caused by Neisseria gonorrhoeae) or nongonococcal in origin (most commonly caused by Chlamydia trachomatis, Mycoplasma genitalium, or Trichomonas vaginalis). The most common signs and symptoms include dysuria, mucopurulent urethral discharge, urethral discomfort, and erythema. Diagnostic criteria include typical signs, symptoms, or history of exposure in addition to mucopurulent discharge, Gram stain of urethral secretions showing at least two white blood cells per oil immersion field, first-void urinalysis showing at least 10 white blood cells per high-power field, or a positive leukocyte esterase result with first-void urine. First-line empiric treatment consists of ceftriaxone and doxycycline; however, the antibiotic regimen may be targeted to the isolated organism. Repeat testing is not recommended less than three weeks after treatment because false-positive results are possible during this time. Patients treated for a sexually transmitted infection should have repeat screening in three months, with shared decision-making about future screening intervals. Patients treated for urethritis should abstain from sex for seven days after the start of treatment, until their partners have been adequately treated, and until their symptoms have fully resolved.

Urethritis refers to inflammation of the urethra. It is classified as gonococcal (caused by Neisseria gonorrhoeae) or nongonococcal in origin. Nongonococcal urethritis can be caused by several other organisms; Chlamydia trachomatis, Mycoplasma genitalium, and Trichomonas vaginalis are the most common. The differential diagnosis of urethritis is summarized in Table 1.

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TABLE 1.

Differential Diagnosis of Urethritis

Chemical irritation

Chronic pelvic pain syndrome

Epididymitis

Genital herpes

Mucositis

Prostatitis (acute or chronic)

Trauma

Urinary tract infection

TABLE 1.

Differential Diagnosis of Urethritis

Chemical irritation

Chronic pelvic pain syndrome

Epididymitis

Genital herpes

Mucositis

Prostatitis (acute or chronic)

Trauma

Urinary tract infection

Epidemiology

The Authors

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JARRETT SELL, MD, FAAFP, AAHIVS, is an associate professor in the Department of Family and Community Medicine at Penn State Health Hershey (Pa.) Medical Center....

MUNIMA NASIR, MD, is an associate professor in the Department of Family and Community Medicine at Penn State Health Hershey Medical Center.

CHLOE COURCHESNE, MD, is an assistant professor in the Department of Family and Community Medicine at Penn State Health Hershey Medical Center. At the time the article was written she was a resident at Penn State Health Hershey Medical Center.

Address correspondence to Jarrett Sell, MD, FAAFP, AAHIVS, Penn State Health Hershey Medical Center, 2626 N. 3rd St., Harrisburg, PA 17110 (email: jsell@pennstatehealth.psu.edu). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

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