Urethritis – 11 Interesting Facts

What is Urethritis

Urethritis is swelling (inflammation) of the urethra. The urethra is the tube that drains urine from the bladder. It is important to get treatment for this condition early. Delayed treatment may lead to complications.

Interesting Facts

  1. Urethritis is inflammation of the urethra, usually due to sexually transmitted gonococcal or nongonococcal infection
  2. Common symptoms in men include dysuria, urinary urgency, urinary frequency, urethral burning and itching, and urethral discharge
  3. Urethritis is often asymptomatic in women, although dysuria may occur
  4. Urethral inflammation is confirmed by finding mucopurulent urethral discharge, pyuria in first-void urine (more than 2 WBCs per oil immersion field), or significant number of WBCs in urethral discharge (more than 10 WBCs per high-power field) 1
  5. If available at the point of care, a stained urethral exudate showing gram-negative intracellular diplococci is presumptive evidence of gonococcal urethritis
  6. Testing for gonococcal and chlamydial infection (using nucleic acid amplification tests) is indicated in all patients with evidence of urethral inflammation or with consistent symptoms
  7. Treat known or suspected gonococcal infection with ceftriaxone plus azithromycin
  8. Treat known or suspected nongonococcal infections with azithromycin or doxycycline
  9. If testing is not available, treat to cover both gonococcal and chlamydial infections
  10. Provide treatment to all sexual partners
  11. Retest all patients with gonorrhea, chlamydia, or trichomonas infection after 3 months

What are the causes?

This condition may be caused by:

  • Germs that are spread through sexual contact. This is the leading cause of urethritis. This may include bacterial or viral infections.
  • Injury to the urethra. Injury can happen after a thin, flexible tube (catheter) is inserted into the urethra to drain urine, or after medical instruments or foreign bodies are inserted into the area.
  • Chemical irritation. This may include contact with spermicide.
  • A disease that causes inflammation. This is rare.

What increases the risk?

The following factors may make you more likely to develop this condition:

  • Having sex without using a condom.
  • Having multiple sexual partners.
  • Having poor hygiene.

What are the signs or symptoms?

Symptoms of this condition include:

  • Pain with urination.
  • Frequent urination.
  • Urgent need to urinate.
  • Itching and pain in the vagina or penis.
  • Discharge coming from the penis.

However, women rarely have symptoms.

How is this diagnosed?

This condition is diagnosed based on your medical history and symptoms as well as a physical exam. Tests may also be done. These may include:

  • Urine tests.
  • Swabs from the urethra.

How is this treated?

Treatment for this condition depends on the cause. Urethritis caused by a bacterial infection is treated with antibiotic medicine. Any sexual partners must also be treated.

Follow these instructions at home:

Medicines

  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • If you were prescribed antibiotic medicine, take it as told by your health care provider. Do not stop taking the antibiotic even if you start to feel better.

Lifestyle

  • Avoid using perfumed soaps, bubble bath, and shampoo when you bathe or shower. Rinse the vaginal area after bathing.
  • Wear cotton underwear. Not wearing underwear when going to bed can help.
  • Make sure to wipe from front to back after using the toilet if you are female.
  • Do not have sex until your health care provider approves. When you do have sex, be sure to practice safe sex.
  • Tell anyone with whom you have had sexual relations in the past 60 days that he or she may be at risk of infection.

General instructions

  • Drink enough fluid to keep your urine clear or pale yellow.
  • It is up to you to get your test results. Ask your health care provider, or the department that is doing the test, when your results will be ready.
  • Keep all follow-up visits as told by your health care provider. This is important.
  • Get tested again 3 months after treatment to make sure the infection is gone. It is important that your sexual partner also gets tested again.

Contact a health care provider if:

  • Your symptoms have not improved after 3 days.
  • Your symptoms get worse.
  • You have eye redness or pain.
  • You develop abdominal pain or pelvic pain (in females).
  • You develop joint pain.
  • You have a fever.

Get help right away if:

  • You have severe pain in the belly, back, or side.
  • You vomit repeatedly.

Summary

  • Urethritis is a swelling (inflammation) of the urethra.
  • This condition is caused by germs that are spread through sexual contact. This is the main cause of this illness.
  • It is important to get treatment for this condition early. Delayed treatment may lead to complications.
  • Treatment for this condition depends on the cause. Any sexual partners must also be treated.

Detailed Information

Pitfalls

  • Inexperienced clinicians may diagnose a urinary tract infection without testing for sexually transmitted infections and treat inappropriately
  • Patients should be supine when collecting urethral specimens, because tolerance of the procedure is better
  • Urethral swabs should be inserted 2 cm into the urethra; if additional swabs are needed, they should be inserted at least 1 cm deeper for best specimen collection 2
  • Urethral swab should be rolled across the microscope slide when a slide of the urethral material is created; this brings all surfaces of the swab in contact with the slide and better preserves the collected cells’ morphologic characteristics
  • Increased risk of coinfection with other sexually transmitted infections (especially with HIV) occurs in patients with urethritis
  • Risk of reinfection is reduced by avoidance of sexual activities for 7 days after treatment, until resolution of symptoms, and until all sexual partners have been treated 3

Terminology

Clinical Clarification

  • Urethritis is inflammation of the urethra, most commonly due to sexually transmitted infection 4

Classification

  • Infectious
    • Gonococcal
    • Nongonococcal
  • Noninfectious
    • Traumatic
    • Idiopathic (in children, also called urethritis of childhood)
      • No infectious organism identified with sensitive testing methods

Diagnosis

Clinical Presentation

History

  • Men and boys with infectious urethritis
    • Dysuria (usually within a month of exposure to sexually transmitted infection)
    • Urethral discharge that may stain underwear
    • Urethral itching, usually at meatus
    • Urethral burning, usually localized to meatus or distal portion of penis
    • Urinary frequency
    • Urinary urgency
    • Mucous strands in urine
  • Women and girls with infectious urethritis
    • Often asymptomatic
    • Cannot symptomatically distinguish urethritis from cystitis
      • Dysuria
      • Urinary frequency
      • Urinary urgency
  • Boys, typically aged 5 to 15 years, with idiopathic urethritis (no causative agent identified) 5
    • Bleeding from urethra is most common presentation; typically occurs after urination, with blood noted at urethral meatus; sometimes presents as hematuria 5
    • Dysuria is also common; sometimes severe 5
    • Symptoms may be brief and self-limited or may persist and/or recur for years

Physical examination

  • Men and boys with infectious urethritis
    • Urethral discharge
      • Milking the penis gently may expel discharge
      • Mucoid to mucopurulent
      • May be thin or thick
      • Usually clear to white with nongonococcal cause
      • More commonly purulent and yellow-green with gonococcal cause
    • Signs of other sexually transmitted infections may be present, including chancres and other sores
    • Epididymal tenderness may be present if infection has spread beyond urethra
  • Women and girls with infectious urethritis
    • Pelvic examination findings are largely normal when urethritis is the only manifestation of a sexually transmitted infection
      • Vaginal or cervical discharge may be present if there is concomitant gonococcal vaginitis or cervicitis
  • Boys with idiopathic urethritis
    • Urethral discharge is absent or minimal

Causes and Risk Factors

Causes

  • Infectious
    • Gonococcal (up to 80% of cases): Neisseria gonorrhoeae 6
    • Nongonococcal
      • Chlamydia trachomatis (15% to 40% of nongonococcal cases) 1
      • Trichomonas vaginalis (20% to 50% of nongonococcal cases) 6
      • Mycoplasma genitalium (15% to 25% of nongonococcal cases) 1
      • Ureaplasma urealyticum (5% to 10% of nongonococcal cases; often detected without symptomatic urethritis) 7
      • Adenovirus (2% to 4% of nongonococcal cases) 7
      • HSV (2% to 3% of nongonococcal cases) 7
  • Traumatic
    • Chemical irritation such as contact with spermicide; alcohol ingestion may also cause mild dysuria
    • Recent instrumentation of urethra
    • Vigorous sexual activity or masturbation
  • Idiopathic
    • Occurs mainly in boys aged 5 to 15 years

Risk factors and/or associations

Sex
  • Typically diagnosed in men or boys; in women it is difficult to distinguish from cystitis, vaginitis, or urinary tract infection
Ethnicity/race
  • Trichomonas vaginalis urethritis is more common in African Americans than in other races in the United States 7
Other risk factors/associations
  • Sexually active
  • Increased incidence of urethritis (both gonococcal and nongonococcal) in summer months

Diagnostic Procedures

Primary diagnostic tools

  • In a symptomatic patient, documentation of urethral inflammation at the point of care by any of the following: 1
    • Visual appearance of mucopurulent or purulent discharge as seen by provider or reported by patient
    • Microscopy of stained discharge confirms inflammation
    • Positive urinalysis findings (positive leukocyte esterase finding or spun-sediment microscopy findings meeting criteria for urethral inflammation)
  • If inflammation is confirmed, obtain nucleic acid amplification tests of urine to identify causative agent 1
  • If inflammation is not confirmed, reevaluate symptomatic men with urine or urethral specimens after several days or proceed to treat sexually active patients who are unlikely to return for repeat assessment 1

Laboratory

  • Microscopy of stained urethral discharge (in men) may be performed to document urethral inflammation, although presence of urethral discharge typically supplies enough evidence to support evaluation by nucleic acid amplification tests and treatment for sexually transmitted infections in most sexually active patients 1
    • Gram stain, methylene blue stain, or gentian violet stain
      • Inflammation is strongly suggested by more than 2 WBCs per oil immersion field
      • WBCs containing gram-negative intracellular diplococci (purple diplococci with methylene blue or gentian violet stains) allow presumptive diagnosis of gonorrhea
      • Mononuclear cells suggest a viral infection
  • Urinalysis of first-void urine 1
    • Finding of more than 10 WBCs per high-power field in spun specimen is diagnostic in men
    • Leukocyte esterase positivity on dipstick test is diagnostic of urinary tract inflammation in men
  • Standard of care is obtaining nucleic acid amplification tests for most likely causative agents 1
    • Obtain nucleic acid amplification tests for gonorrhea and chlamydia for all patients with urethritis 1
      • Test urethral specimen in men (first-catch urine may be used according to the CDC) 2
      • Test vaginal, cervical, or urine specimen in women 1
    • Obtain nucleic acid amplification tests for trichomonas when it is clinically suspected (eg, known contact with trichomonas), in areas of high prevalence, and when urethritis fails to respond to recommended therapy 1
      • Not FDA-cleared in the United States; testing validated by the Clinical Laboratory Improvement Amendments program, which is available in some large reference laboratories, is necessary (more sensitive than culture) 1
      • Nucleic acid amplification test for trichomonas is recommended over wet mount microscopy, owing to poor sensitivity of wet mount microscopy (51% to 65%); with nucleic acid amplification test, 3 to 5 times more trichomonas infections can be detected compared with wet mount technique
    • Nucleic acid amplification test for HSV if examination or history raise suspicion for the virus 8
  • For all patients with urethritis, obtain tests for other sexually transmitted infections 1
    • HIV testing: serology for antibodies against HIV-1 and HIV-2
    • Syphilis testing: a nontreponemal test (ie, VDRL test or rapid plasma reagin test), followed by a treponemal test (eg, fluorescent treponemal antibody absorption test) for confirmation

Differential Diagnosis

Most common

  • Women
    • Cervicitis
      • Commonly, patient is asymptomatic
      • If symptomatic, may have vaginal discharge or postcoital bleeding
      • Less commonly, dysuria and urinary frequency
      • Diagnosis is aided by pelvic examination finding of mucopurulent endocervical exudate, with microscopy and microbiologic testing of discharge
    • Vaginitis
      • Presents with vaginal discharge
      • Dysuria may be present
      • Usually caused by bacterial vaginosis, trichomoniasis, or vulvovaginal candidiasis
      • Diagnosis is aided by pelvic examination and testing of vaginal discharge
        • Microscopy of wet mount, potassium hydroxide preparation, and testing of vaginal pH suggest one of these common causes
    • Cystitis
      • Infection of bladder typically causes dysuria and urinary frequency
      • Suprapubic tenderness is common
      • Urinalysis (finding pyuria and bacteriuria) and urine culture aid in diagnosis; for women, a urine specimen obtained by catheterization is required to differentiate if there is vaginal discharge
  • Men
    • Epididymo-orchitis
      • Causes pelvic and scrotal discomfort in addition to urinary frequency
      • Typically caused by gonococcal or chlamydial infections in younger, sexually active men and by other pyogenic bacteria in older men
      • Isolated orchitis (without epididymitis) may be caused by mumps infection
      • Diagnosis can be made by examination of scrotum, with findings of swelling and diffuse testicular and/or epididymal tenderness
      • Urine culture and/or nucleic acid amplification test identify infectious agent
    • Prostatitis
      • Urinary frequency, dysuria, and pelvic discomfort may be present
      • Fever, chills, and deep pelvic pain may be present
      • Examination of prostate and analysis of prostatic fluid typically render diagnosis
        • Prostate typically is enlarged, boggy, and tender
        • Pressing on prostate several times with gloved finger, followed by gently milking urethra, allows prostatic fluid to be collected
        • Prostatic fluid is evaluated by microscopy for evidence of infection
    • Urethral stricture
      • Dysuria and frequent urination may accompany urethral stricture even when urethral inflammation and infection are not present
      • Seen in men who have received urologic instrumentation in the past (eg, transurethral surgery, cystoscopy, Foley catheter), have had injury to penis, or have had urinary infection
      • Referral to urologist for measurement of urine flow rate and for cystoscopy may be required to diagnose

Treatment

Goals

  • Eradicate infection (if present)
  • Resolve symptoms
  • Concurrently treat partners of patients who are receiving antibiotics for a sexually transmitted infection

Disposition

Recommendations for specialist referral

  • Refer the following patients to a urologist:
    • Men with persistent urinary tract symptoms or signs, including the following: urethral, penile, or pelvic pain; voiding discomfort; pain during or after ejaculation; or new-onset premature ejaculation lasting longer than 3 months 1
    • Men or women who have persistent nongonococcal urethritis despite standard presumptive treatment for chlamydia, followed by presumptive treatment for mycoplasma and trichomonas

Treatment Options

Therapy is presumptive based on suspected pathogen at time of diagnosis; generally initial treatment covers gonorrhea and chlamydia 1

Gonococcal urethritis (based on diagnostic microscopy of stained urethral discharge or nucleic acid amplification test): treat with intramuscular ceftriaxone plus azithromycin 1

  • If ceftriaxone is unavailable, oral cefotaxime plus azithromycin is an acceptable (although less bactericidal) alternative 1
  • In the setting of cephalosporin allergy or IgE-mediated penicillin allergy, the CDC suggests gentamicin as a ceftriaxone alternative; however, there is no evidence of superiority of gentamicin over several other alternative antibiotics (eg, kanamycin, ciprofloxacin, gemifloxacin, trimethoprim-sulfamethoxazole) 9

Nongonococcal urethritis, based on (1) confirmation of urethral inflammation without evidence of gonococcal infection or (2) positive result on nucleic acid amplification test: treat with azithromycin or doxycycline 1

Treat presumptively for both gonococcal and chlamydial infection while awaiting test results (eg, nucleic acid amplification test results), especially when managing patients who are sexually active and are unlikely to return for repeat assessment 1

Persistent or recurrent nongonococcal urethritis suggests inadequately treated Mycoplasma genitalium infection or trichomonas infection 1

  • If treated initially with azithromycin, retreat with moxifloxacin for presumed Mycoplasma genitalium infection
  • For men who have sex with women, and when there are locally high rates of trichomonas infection, treat with metronidazole

For all sexual partners within the past 60 days: evaluate, test, and appropriately treat, or give expedited partner treatment with oral cefixime plus azithromycin where permitted by law 1

  • If providing expedited partner treatment, provide written information to give to the partner, including instructions and warnings about taking the medication (eg, pregnancy, allergy). This action tends to increase the capture of infected persons for treatment
  • Referral to local health department may accomplish partner notification and treatment; check with local health department

For symptomatic men who are considered to be at high risk for infection and are not likely to return for follow-up: treat empirically for chlamydial and gonococcal infection 1

Idiopathic urethritis in boys requires urologic referral for consideration of urethral steroids or short-term urethral catheterization 5

Drug therapy

  • Gonococcal urethritis
    • Cephalosporins 1
      • Ceftriaxone
        • Ceftriaxone Sodium Solution for injection; Children† and Adolescents† 8 years and older weighing 45 kg or more: CDC and AAP recommend 250 mg IM x1 dose with with azithromycin 1 g PO x1 dose. Ceftriaxone 250 mg IM x1 dose plus azithromycin 2 g PO x1 dose recommended with treatment failure after alternative regimen of cefixime and azithromycin. For drug-resistant strains, WHO recommends 500 mg to 1g IM x1 with patient review in 10—14 days. If infection persists, azithromycin with gentamicin or spectinomycin may be appropriate. Appropriately treat sexual partners.
        • Ceftriaxone Sodium Solution for injection; Adults: Manufacturer and CDC recommend 250 mg IM as single dose with azithromycin 1 g PO as single dose. Ceftriaxone 250 mg IM as single dose plus azithromycin 2 g PO as single dose recommended with treatment failure after alternative regimen of cefixime and azithromycin. For drug-resistant strains, WHO recommends 500 mg to 1 g IM as single dose with patient review in 10 to 14 days. If infection persists, azithromycin with gentamicin or spectinomycin may be appropriate. Appropriately treat sexual partners.
      • Cefixime
        • Cefixime Oral capsule; Adults, Adolescents, and Children weighing 45 kg or more: As alternative, 400 mg PO once plus azithromycin 1 g PO once. Ceftriaxone is preferred agent; cefixime not recommended for pharyngitis.
    • Macrolides
      • Azithromycin
        • Azithromycin Oral tablet; Adolescents and Adults (13+ years): 1 g PO as a single dose in combination with ceftriaxone or cefixime.
  • Initial treatment of nongonococcal urethritis
    • Macrolides
      • Azithromycin 1
        • Azithromycin Oral tablet; Adolescents and Adults (13+ years): 1 g PO as a single dose.
    • Tetracyclines
      • Doxycycline
        • Doxycycline Hyclate Oral tablet; Adults, Adolescents, and Children 8 years and older weighing 45 kg or more: 100 mg PO every 12 hours for 7 days. Use with anti-gonorrhea agent when appropriate.
  • Treatment of recurrent or persistent urethritis suspected to be caused by Mycoplasma genitalium
    • Fluoroquinolones
      • Moxifloxacin
        • Moxifloxacin Hydrochloride Oral tablet; Adults: CDC suggests 400 mg PO daily x7 days in patients with recurrent/persistent NGU who fail azithromycin for M. genitalium.
  • Treatment of recurrent or persistent urethritis suspected to be caused by Trichomonas vaginalis
    • Nitroimidazoles
      • Metronidazole 1
        • Metronidazole Oral tablet; Adults (18+ years): 2 g PO as a single dose.
      • Tinidazole 1
        • Tinidazole Oral tablet; Adults (18+ years): 2 g PO as a single dose.

Nondrug and supportive care

  • For all sexual partners of patients with gonococcal or nongonococcal urethritis within the preceding 60 days: refer for examination, testing, and presumptive treatment; referral to local health department may accomplish this 1
  • Treatment of partners who otherwise may not be seen is possible with expedited partner therapy where allowed (most states); direct dispensing is preferred to providing a prescription, owing to treatment adherence concerns 1
    • Prescription for the partner is generally given to the patient to then give to the partner; providing the medications directly in an appropriate package is preferred, according to the CDC
      • Oral cefixime plus azithromycin is recommended for partner therapy
      • In general, by providing written instructions, including information on drug allergies, clinicians are protected by law in providing expedited partner therapy 10
    • Providers may contact the CDC for information specific to their state 11
  • Reduce reinfection by recommending avoidance of sexual activities for 7 days after treatment, until resolution of symptoms, and until all sexual partners have been treated 1

Comorbidities

  • Cephalosporin allergy
    • Ceftriaxone and cefixime are contraindicated with history of IgE-mediated penicillin allergy (eg, anaphylaxis, Stevens-Johnson syndrome, toxic epidermal necrolysis) 1
    • Potential alternative therapies for gonorrhea should be considered in consultation with an infectious disease specialist 1
      • CDC suggests intramuscular gentamicin as a ceftriaxone alternative; however, there is no evidence of superiority of gentamicin over several other alternative antibiotics (eg, kanamycin, ciprofloxacin, gemifloxacin, trimethoprim-sulfamethoxazole) 9
  • If patient treated initially with doxycycline is still symptomatic, retreat with azithromycin for presumed Mycoplasma genitalium infection

Special populations

  • Pregnant women
    • Treat gonococcal urethritis with ceftriaxone and azithromycin
      • With cephalosporin allergy in a pregnant woman, consider spectinomycin in consultation with an infectious disease specialist 1
    • For nongonococcal urethritis, doxycycline is contraindicated in the third trimester; studies suggest azithromycin is safe 1

Monitoring

  • Even if patient is asymptomatic after treatment, with a specific diagnosis of chlamydia, gonorrhea, or trichomonas urethritis, do the following:
    • Repeat nucleic acid amplification testing 3 months after treatment because of high rates of reinfection, even if sex partners were treated
  • With or without a specific etiologic diagnosis
    • Repeat physical examination, microscopy of stained urethral exudate, and nucleic acid amplification test if signs or symptoms persist after treatment
  • During pregnancy 1
    • Test-of-cure to document chlamydial eradication (preferably by nucleic acid amplification test) is recommended (3 to 4 weeks after completion of therapy)
    • In addition, for all pregnant women who have chlamydial infection diagnosed, retest 3 months after treatment

Complications and Prognosis

Complications

  • Local complications in males
    • Acute epididymitis
      • Most commonly due to gonococcal or chlamydial infection in men aged 35 years or younger 1
    • Balanoposthitis
      • Increased likelihood of being due to trichomonas infection, but may develop with other infections, including chlamydia and herpes simplex virus
    • Prostatitis
      • Prostatic involvement can be documented in 20% to 30% of men with untreated nongonococcal urethritis 6
    • Urethral stricture
      • Stricture can develop after either gonococcal or nongonococcal infection when infection is not treated or is recurrent
      • Boys with idiopathic urethritis are at higher risk 5
    • Infertility
      • Male infertility may result from gonococcal or chlamydial epididymitis
      • Untreated infection (chronic epididymitis) leads to damage of the epididymis and testicle, which may cause infertility
      • Decreased fertility has been reported to occur after a single episode of gonococcal unilateral epididymo-orchitis 12
  • Persistent/recurrent nongonococcal urethritis
    • Occurs in 10% to 20% of patients with nongonococcal urethritis 13
    • Most commonly due to Mycoplasma genitalium (20% to 40% 7), especially after doxycycline therapy
    • May be due to Trichomonas vaginalis infection, especially in areas of local prevalence 7 and in men who have sex with women 1
    • Chlamydia accounts for 10% to 20% of persistent cases 7
  • Disseminated gonorrhea
    • Occurs in 0.4% to 3% of cases of gonorrhea 14
    • Tends to occur in younger age groups (below 40 years) and has been seen more often in women than men
    • Commonly presents with rash and arthritis
  • Pelvic inflammatory disease may result from ascending gonococcal or nongonococcal urethritis in females
    • Infertility develops in 10% of women after 1 episode of pelvic inflammatory disease 15
  • Reactive arthritis (nongonococcal urethritis plus arthritis, uveitis, and possibly lesions of the skin and mucous membranes)
    • Complicates 1% to 2% of cases of nongonococcal urethritis 6
    • HLA-B27 is found in 90% to 96% of patients 6
    • Chlamydia trachomatis is strongly implicated as cause
  • Conjunctivitis
    • Conjunctiva can be infected by Neisseria gonorrhoeae or Chlamydia trachomatis
    • Sporadic cases of gonococcal conjunctivitis from an anogenital source are reported
    • Conjunctivitis develops in 1 in 300 patients with genital chlamydia 16
    • An oculogenital syndrome of nongonococcal urethritis and conjunctivitis occurs in 4% of nongonococcal urethritis cases 6

Prognosis

  • With early treatment, prognosis is good with no complications expected
  • Delayed treatment may allow development of local and systemic complications

Screening and Prevention

Screening

At-risk populations 1

  • For all sexually active women younger than 25 years: screen annually for gonococcal and chlamydial infection
  • For women aged 25 years or older: screen if at high risk (eg, new sex partner, more than 1 sex partner, sex partner with sexually transmitted infection)
  • For men who have sex with men: offer annual screening for chlamydial and gonococcal infection
  • For other sexually active young men: Routine screening is not recommended, but screening should be considered depending on treatment setting and risk
    • Consider screening in clinical settings serving populations of adolescent males and young men with high prevalence of sexually transmitted infection
      • Men in correctional facilities
      • Sexually transmitted disease clinics
      • Adolescent health clinics

Screening tests 1

  • Nucleic acid amplification test of endocervical specimen for women
  • Nucleic acid amplification test of urine for men

Prevention

  • Avoidance of oral, vaginal, or anal sex or engaging in sexual activity only within a mutually monogamous long-term relationship are the most reliable methods for avoidance of urethritis and other sexually transmitted infections 1
  • Consistent use of a condom lowers the risk of developing urethritis or another sexually transmitted infection 1

Sources

Workowski KA et al: Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 64(RR-03):1-137, 2015

Cross Reference

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