Urethritis

Question 1

Urethritis

Answer 1

Inflammation of the urethra, most often due to infection

Gonococcal urethritis or non-gonococcal urethritis

Question 2

Types of urethritis

Answer 2

Gonococcal urethritis - N. gonorrhoeae

Non-gonococcal urethritis - Chlamydia trachomatis, followed by Mycoplasma genitalium, and Trichomonas vaginalis

Question 3

Risk Factors

Answer 3

age <25yrs

Gay

Previous STI

Recent new sexual partner

More than one partner in the last year.

Question 4

Clinical Features

Answer 4

Dysuria
Penile irritation
Discharge from the urethral meatus

Question 5

Complications

Answer 5

Reactive Arthritis - resolve within 6 months

Question 6

Balanitis

Answer 6

Inflammation of the glans penis

Question 7

Ix

Answer 7

Urethral gram stain and microscopy

First-void urine (NAAT)

Mid-stream urine dipstick

STI screen - HIV and syphilis serology

Question 8

First-void urine (NAAT)

Answer 8

Test for:

• N. gonorrhoeae
• C. trachomatis
• M. genitalium

Question 9

Management

Answer 9

Abx management

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

Non-gonococcal = Doxycycline 100mg PO for 7 days OR Azithromycin 1g PO single dose

Trichomonas - Metronidazole

Question 10

Long-term Management

Answer 10

Abstain from sexual activity for 7 days after:

• antibiotic course is finished
• symptoms have resolved
• sexual partners have been treated
• gonorrhoea - test of cure is required

Question 11

Advice

Answer 11

Condom use

Notify their sexual partners to attend GUM clinic for testing