What is urethritis?
Inflammation of the urethra, most often due to infection
How can infectious urethritis be classified?
- Gonococcal
- Non-gonococcal
What causes gonoccocal urethritis?
N. gonorrhoea
What cause non-gonoccocal urethritis?
Most commonly;
- C. trachomatis
- M genitalum
- T. vaginalis
What are the main risk factors for urethritis
- <25 years
- MSM
- Previous STI
- Recent new sexual partner
- More than one partner in last year
What are the typical presenting features of urethritis?
- Dysuria
- Penile irritation
- Discharge from urethral meatus
What is the importance of taking a thorough sexual history in urethritis?
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
How else might patients present with urethritis?
Features from complications of urethritis, such as epididymitis or reactive arthritis
What are the differential diagnoses of urethritis?
- Balanitis
- Acute prostatitis
- Cystitis
What is balantitis?
Inflammation of glans penis
How does balanitis present?
- Pruritis
- Erythema
- Discharge between foreskin and glans
Who is balantitis more common in, compared to urethritis?
Older patients
What can balanitis be secondary to?
Bacterial or fungal infection
How might acute prostatitis present?
- LUTS
- Ejaculatory pain
- Pain in penis, perineum, or rectum
- Any urethral discharge often blood tinged
What investigations may be done in urethritis?
- 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
What findings on microscopy suggest urethritis?
Pus cells
What finding on microscopy is highly suggestive of gonococcal infection?
Any presence of gram -ve diplococci
What is the gold standard for diagnosis of urethritis?
First void urine sent for NAAT
When should triple site testing be done in urethritis?
In gonoccocal infection
What is the mainstay of initial management of urethritis?
Antibiotics
What is the first line management for gonococcal urethritis?
Cefriaxone 1g IM single dose
What is the first line management for non-gonoccal urethritis?
Doxycycline 100mg PO BD
What antibiotic should be considered if trichomonas are seen on microscopy?
Metronidazole 2g PO single dose
What else should be involved in the management of urethritis?
- Abstain from sexual activity
- Counsel patients on condom use
- Advise patients to notify their sexual partners to attend GUM clinic for testing and treatment
