Urethritis in men: Difference between revisions

Revision as of 11:13, 31 October 2017

Background

Genitourinary infection

(1) Human urinary system: (2) kidney; (3) renal pelvis; (4) ureter; (5) urinary bladder (6) urethra.
Additional structures: (7) adrenal gland; (8) renal artery and vein; (9) inferior vena cava; (10) abdominal aorta; (11) common iliac artery and vein; (12) liver; (13) large intestine; (14) pelvis.

"UTI" frequently refers specifically to acute cystitis, but may also be used as a general term for all urinary infections; use location-specific diagnosis.

Renal/perirenal
Ureteral
- Infected urolithiasis
Bladder
- Acute cystitis ("UTI")
- Chronic cystitis
Urethra/periurethra
- Urethritis
- Prostatitis

Clinical Features

Dysuria
Urethral discharge

Differential Diagnosis

Dysuria

Genitourinary infection
- Acute cystitis ("UTI")
- Pyelonephritis
- Urethritis
- Chronic cystitis
- Infected nephrolithiasis
- Prostatitis
- Epididymitis
- Renal abscess/perinephric abscess
- Emphysematous pyelonephritis
Nephrolithiasis
Urethral issue
- Urethritis
- Urolithiasis
- Urethral foreign body
- Urethral diverticulum
- Allergic reaction (contact dermatitis)
- Chemical irritation
- Urethral stricture or obstruction
- Trauma to vagina, urethra, or bladder
Gynecologic
- Vaginitis/cervicitis
- PID
- Genital herpes
- Pelvic organ prolapse
- Fistula
- Cystocele
Other
- Diverticulitis
- Interstitial cystitis
- Behavioral symptom without detectable pathology

Evaluation

Workup

UA
Urine GC/chlamydia

Diagnosis

Typically initially a clinical diagnosis with empiric treatment

Management

Treatment to cover both gonorrhea and chlamydia

Uncomplicated Infection

Ceftriaxone 250mg IM once, PLUS
- Azithromycin 1g PO once OR
- Doxycycline 100mg PO BID x 7 days

Cephalosporin Allergy

Azithromycin 2g PO once, PLUS
- Gentamicin 240mg IM once^[1]
- In theory this high dose macrolide will provide treatment for both GC and Chlamydia

Partner treatment

Cefixime 400mg PO once, PLUS
- Azithromycin 1g PO once, OR
- Doxycycline 100mg PO BID x 7 days

Recurrent or Persistent

Target M. genitalium

Moxifloxacin 400 mg daily x 7 days

Consider coverage of T. vaginalis, among men who have sex with women

Metronidazole 2 gm PO x 1, OR
Tinidazole 2 gm PO x 1

Disposition

Outpatient

References

↑ CDC: 2015 Sexually Transmitted Diseases Treatment Guidelines

Authors:

[1] CDC: 2015 Sexually Transmitted Diseases Treatment Guidelines

[1]

@@ Line 18: / Line 18: @@
 ==Management==
-''Initial antimicrobial treatment is typically empiric, depending on risk for gonococcal versus nongonococcal urethritis''
+''Treatment to cover both [[gonorrhea]] and [[chlamydia]]''
+====Uncomplicated Infection====
+*[[Ceftriaxone]] 250mg IM once, '''PLUS'''
+**[[Azithromycin]] 1g PO once '''OR'''
+**[[Doxycycline]] 100mg PO BID x 7 days
-===[[Gonococcal]]===
+====Cephalosporin Allergy====
-''Will also treat [[chlamydia]]''
+*[[Azithromycin]] 2g PO once, '''PLUS'''
-*[[Ceftriaxone]] 250 mg IM x 1, '''PLUS'''
+**[[Gentamicin]] 240mg IM once<ref>[http://www.cdc.gov/std/tg2015/ CDC: 2015 Sexually Transmitted Diseases Treatment Guidelines]</ref>
-*[[Azithromycin]] 1 gm PO x 1
+**In theory this high dose macrolide will provide treatment for both [[GC]] and [[Chlamydia]]
-===Nongonococcal===
+====Partner treatment====
-''[[Chlamydia]] most likely pathogen''
+*[[Cefixime]] 400mg PO once, '''PLUS'''
-*[[Azithromycin]] 1 gm PO x 1, '''OR'''
+**[[Azithromycin]] 1g PO once, '''OR'''
-*[[Doxycycline]] 100 mg  PO BID x 7 days
+**[[Doxycycline]] 100mg PO BID x 7 days
 ===Recurrent or Persistent===
 ''Target [[M. genitalium]]''
-*[[Azithromycin]] 1 gm PO x 1 (if not administered in the initial regimen), '''OR'''
+*[[Moxifloxacin]] 400 mg daily x 7 days
-*[[Moxifloxacin]] 400 mg daily x 7 days (if the initial failed regimen included azithromycin)
 ''Consider coverage of [[T. vaginalis]], among men who have sex with women''