Urethritis

Question 1

What is urethritis?

Answer 1

Inflammation of the urethra, most often due to infection

Question 2

How can infectious urethritis be classified?

Answer 2

• Gonococcal

- Non-gonococcal

Question 3

What causes gonoccocal urethritis?

Answer 3

N. gonorrhoea

Question 4

What cause non-gonoccocal urethritis?

Answer 4

Most commonly;

• C. trachomatis
• M genitalum
• T. vaginalis

Question 5

What are the main risk factors for urethritis

Answer 5

• <25 years
• MSM
• Previous STI
• Recent new sexual partner
• More than one partner in last year

Question 6

What are the typical presenting features of urethritis?

Answer 6

• Dysuria
• Penile irritation
• Discharge from urethral meatus

Question 7

What is the importance of taking a thorough sexual history in urethritis?

Answer 7

Can help narrow down the likely pathogens and risk stratify the burden of disease, as well as inform necessary additional sexual health screens and partner notification

Question 8

How else might patients present with urethritis?

Answer 8

Features from complications of urethritis, such as epididymitis or reactive arthritis

Question 9

What are the differential diagnoses of urethritis?

Answer 9

• Balanitis
• Acute prostatitis
• Cystitis

Question 10

What is balantitis?

Answer 10

Inflammation of glans penis

Question 11

How does balanitis present?

Answer 11

• Pruritis
• Erythema
• Discharge between foreskin and glans

Question 12

Who is balantitis more common in, compared to urethritis?

Answer 12

Older patients

Question 13

What can balanitis be secondary to?

Answer 13

Bacterial or fungal infection

Question 14

How might acute prostatitis present?

Answer 14

• LUTS
• Ejaculatory pain
• Pain in penis, perineum, or rectum
• Any urethral discharge often blood tinged

Question 15

What investigations may be done in urethritis?

Answer 15

• Urethral gram stain under microscopy performed on urethral swabs if available
• First void urine sent for NAAT
• Mid stream urine dipstick
• Triple site testing for culture
• Further STI testing

Question 16

What findings on microscopy suggest urethritis?

Answer 16

Pus cells

Question 17

What finding on microscopy is highly suggestive of gonococcal infection?

Answer 17

Any presence of gram -ve diplococci

Question 18

What is the gold standard for diagnosis of urethritis?

Answer 18

First void urine sent for NAAT

Question 19

When should triple site testing be done in urethritis?

Answer 19

In gonoccocal infection

Question 20

What is the mainstay of initial management of urethritis?

Answer 20

Antibiotics

Question 21

What is the first line management for gonococcal urethritis?

Answer 21

Cefriaxone 1g IM single dose

Question 22

What is the first line management for non-gonoccal urethritis?

Answer 22

Doxycycline 100mg PO BD

Question 23

What antibiotic should be considered if trichomonas are seen on microscopy?

Answer 23

Metronidazole 2g PO single dose

Question 24

What else should be involved in the management of urethritis?

Answer 24

• Abstain from sexual activity
• Counsel patients on condom use
• Advise patients to notify their sexual partners to attend GUM clinic for testing and treatment

Question 25

How long should urethritis patients abstain from sexual activity?

Answer 25

7 days after antibiotic course is finished, symptoms have resolved, and their sexual partners have been treated

Question 26

What follow up is required in cases of gonoccocal urethritis?

Answer 26

Test of cure