Urethritis

Question 1

What is urethritis?

Answer 1

Inflammation of the urethra most often due to an infection.

Question 2

How can urethritis be classified?

Answer 2

Gonococcal urethritis - cuased by N.gonorrhoeae

Non-gonococcal urethritis - mostly by C.trachomatis followed by M.genitalium and T.vagninalis.

Question 3

What are the risk factors for urethritis?

Answer 3

Age <25 
MSM 
Previous STI 
Recent new sexual partner 
More than one partner in the last year

Question 4

What are the clinical features of urethritis?

Answer 4

Dysuria, penile irritaion and discharge frm urethral meatus

Through sexual history required.

May presnt with complications of urethritis such as epididymitis or reactive arthritis.

Question 5

What are the differential diagnosis for urethritis?

Answer 5

Balanitis
Acute prostatitis
Cystitis

Question 6

What investigations should be done for urethritis?

Answer 6

Urethral gram stain under microscopy - urethral swabs - gram negativ diplococci are highly sensitive for gonococcal infection.

Gold standard - first-void urine sent for nucleic acid amplification test (NAAT)

Mid-stream urine dipstick and culture

Consider STI screening

Question 7

What is the intial antibiotic management of gonococcal urethritis?

Answer 7

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

Question 8

What is the antibiotic regime for non-gonococcal urethritis?

Answer 8

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

Mycoplasma genitalium growing concern as an under-treated cause ans increasing relevant to run tests in cases of these infections.

Question 9

What is the long term management for urethritis?

Answer 9

Abstain from sexual activity for 7 days after antibiotic course is finished, symptoms have resloved and sexual partners have been treated. In cases of gonorrhoea a test of cure is required.

Condom use and advise to notify sexual partners to attend GUM clinic