What is urethritis?
Inflammation of the urethra most often due to infection.
What types of urethritis are there?
Gonococcal urethritis caused by N. gonorrhoeae
What is non-gonococcal urethritis caused by?
Most commonly C. trachomatis
Can also be M. genitalium and T. vaginalis
Men who have sex with men
Recent new sexual partner
More than one partner in the last year
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.
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.
What will gram stain show?
Pus cells suggest urethritis
Gram negative diplococci is highly sensitive for gonococcal infection
Initial management of gonococcal
Ceftriaxone 1g IM single dose + Azithromycin 1g PO single dose
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
Recurrent non-gonococcal treatment
Azithromycin 500mg PO stat and 250 mg for 2 days
Moxifloxacin 400mg PO OD for 10-14 days
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
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
Symptomatic vs non-symptomatic gonorrhoea
How long to notify
Symp = Previous 2 weeks
Non-symp = Previous 3 months
Symptomatic vs non-symptomatic Chlamydia.
When to notify
Symp = Previous 4 weeks
Non-symp = Previous 6 mo
Symptomatic vs non-symptomatic non-specific urethritis.
When to notify?
Previous 4 weeks regardless