Urethritis

Question 1

What is urethritis?

Answer 1

Inflammation of the urethra

Question 2

Non-infectious causes of urethritis?

Answer 2

Trauma
Reiter’s
Urethral stricture
Urethral stone
Urethral lesions

Question 3

Infectious causes of urethritis?

Answer 3

Gonococcal urethritis
“GNID’s”

Non-gonococcal urethritis: 
Chlamydia trachomatis
Mycoplasma genitalium
(Mycoplasma hominis)
(Ureaplasma urealyticum)
(Trichomonas vaginalis)
(Herpes simplex)
(Adenovirus)

Question 4

Presentation of urethritis?

Answer 4

Dysuria, urethral discharge, urethral pruritis

Question 5

H & P for gonorrhea v. chlamydia?

Answer 5

Gonorrhea: profuse purulent discharge

Chlamydia: clear or purulent or absent discharge

Question 6

What labs should you check for urethritis?

Answer 6

First void urinalysis: leukocyte esterase, > 10 WBC/hpf

Gram stain of urethral discharge >5 WBC/oil immersion field

test for gonorrhea: culture or NAAT

test for chlamydia: culture or NAAT

Question 7

How do you obtain a gonorrhea/chlamydia culture?

Answer 7

urethral swab

• 1 hr after voiding
• if dc > collect specimen at meatus
• if no dc > insert swab 2-4 cm & rotate

Question 8

Tx for gonorrhea?

Answer 8

Ceftriaxone 250 mg IM x 1 dose

Alternative: cefixime 400 mg po x 1 dose

Question 9

Tx for chlamydia?

Answer 9

Azithromycin 1 g po x 1 dose or Doxycylcline 100 mg po bid x 7d

Question 10

Pts with urethritis should abstain from sex for…

Answer 10

7 days after tx initiated

Question 11

FU for gonorrhea?

Answer 11

If received alternative treatment, test for cure 1 week after treatment

At 3 months after treatment, test for cure (for both recommended AND alternative treatment)

Question 12

FU for chlamydia?

Answer 12

Uncomplicated urethritis responsive to treatment: don’t need FU

Pregnant pt: f/u test for cure 3-4 wk after completion of treatment

Question 13

Additional FU for urethritis?

Answer 13

refer sex partners for eval

tx those who had sex within the 60 days prior to onset of sxs