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Y3M - Urology > Urethritis > Flashcards

Flashcards in Urethritis Deck (16)
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1

What is urethritis?

Inflammation of the urethra most often due to infection.
 

2

What types of urethritis are there?

Gonococcal urethritis caused by N. gonorrhoeae

Non-gonococcal urethritis

3

What is non-gonococcal urethritis caused by?

Most commonly C. trachomatis

Can also be M. genitalium and T. vaginalis

4

Risk factors

<25 yo

Men who have sex with men

Previous STI

Recent new sexual partner

More than one partner in the last year

5

Clinical features

Dysuria

Penile irritation

Discharge from urethral meatus

 

Do a thorough sexual history to narrow down the likely pathogens.

They might also present with complications of urethritis like epididymitis or reactive arthritis.

6

Dx

Balanitis

Acute prostatitis

Cystitis

7

Investigations

Urethral gram stain under microscopy from urethral swab.

Gold standard is first-void urine being sent for NAAT for N. gonorrhoeae, C. trachomatis and M. genitalium.

Mid-stream urine dipstick should be done with culture MC&S.

Triple site testing for culture should be done in the case of gonococcal infection.

Consider further STI screening of HIV and syphilis if appropriate.

8

What will gram stain show?

Pus cells suggest urethritis

Gram negative diplococci is highly sensitive for gonococcal infection

9

Initial management of gonococcal

Ceftriaxone 1g IM single dose + Azithromycin 1g PO single dose

10

Initial management of non-gonococcal

Doxycyclina 100mg PO BD for 7 days or Azithromycin 1g PO single dose

If trichomonas is found consider Metronidazole 2g PO single dose 

11

Recurrent non-gonococcal treatment

Azithromycin 500mg PO stat and 250 mg for 2 days 

or

Moxifloxacin 400mg PO OD for 10-14 days

12

Long-term management

Abstain from sexual activity for 7 days after abx course is finish, symptoms have resolved, and sexual partner has been treated.

In the case of gonorrhoea, a test of cure is required

Advise on condom use and advise patient to notify their sexual partners to attend the GUM clinic for testing and treatment

13

Explain required contact tracing.

If symptomatic = Need to notify a shorter time span (weeks vs NS months)

If chlamydia it is a longer time span (2wks Gon vs. 4 wks Cla)

If it is non-specific = always 4 wks

14

Symptomatic vs non-symptomatic gonorrhoea

How long to notify

Symp = Previous 2 weeks

Non-symp = Previous 3 months

15

Symptomatic vs non-symptomatic Chlamydia.

When to notify

Symp = Previous 4 weeks

Non-symp = Previous 6 mo

16

Symptomatic vs non-symptomatic non-specific urethritis.

When to notify?

Previous 4 weeks regardless