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Urethritis

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Overview

Urethritis describes the inflammation of the urethra that is usually (but not always) due to sexually transmitted infections.

It can be divided into gonococcal urethritis, and non-gonococcal urethritis (NGU), however, NGU is increasingly being referred to as non-specific urethritis (NSU).

Persistent/recurrent urethritis is urethritis that occurs 30-90 days after treatment for acute NGU.

Epidemiology

  • In the UK, >100,000 cases of male urethritis are diagnosed yearly
  • Non-gonococcal urethritis (NGU) is thought to be more common than gonococcal urethritis

Causes

Overview

Urethritis is commonly (but not always) caused by sexually transmitted infections. Its causes include:

  • Gonococcal urethritis – Neisseria gonorrhoeae
  • Non-gonococcal urethritis:
    • Up to 50% of cases have no identifiable cause
    • If an organism is found, Chlamydia trachomatis and Mycoplasma genitalium are most likely to be found
    • Other, less common organisms include Ureaplasma urealyticum, Trichomonas vaginalis, and organisms implicated in urinary tract infections (UTIs) such as Escherichia coli
  • Non-infective causes include:

Presentation

Overview

The main feature of urethritis is urethral discharge which may be minimal or copious, may contain blood, and may be more noticeable after holding in urine. Many patients are asymptomatic (~25%).

Other features may include:

Investigations

Referral

All men with suspected urethritis should be referred to a genitourinary medicine (GUM) clinic for diagnosis as a common underlying cause is a sexually transmitted infection. If do not wish to attend one, they can be managed in primary care.

Investigations

Investigations include:

  • First-void urine sample for nucleic acid amplification testing (NAAT):
    • Screens for gonorrhoea and Chlamydia
  • Urethral swab:
    • Performed if NAAT is unavailable
    • Leukocytes are present and Gram-negative diplococci may be seen, suggesting Neisseria gonorrhoeae 

Management

Overview

Management involves treating empirically for the underlying sexually transmitted infection. Ideally, this should be done in a GUM clinic, however, if they wish not to attend one, they should be managed in primary care.

Prognosis

  • Symptoms usually resolve within 3 days of treatment
  • Recurrence is usually due to reinfection or treatment failure

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