Urethritis in men: Difference between revisions
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==Background== | ==Background== | ||
[[File:Prostatelead.jpg|thumb|Urethral anatomy]] | |||
{{UTI types}} | {{UTI types}} | ||
==Clinical Features== | ==Clinical Features== | ||
[[File:SOA-Chlamydia-trachomatis-male.jpg|thumb|[[Chlamydia trachomatis]] on male GU exam consistent with urethritis.]] | |||
*Dysuria | *Dysuria | ||
*Urethral discharge | *Urethral discharge | ||
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==Evaluation== | ==Evaluation== | ||
===Workup=== | ===Workup=== | ||
* | *[[Urinalysis]] | ||
*Urine GC/chlamydia | *Urine GC/chlamydia | ||
*Consider M. genitalium and trichomonas testing | |||
===Diagnosis=== | ===Diagnosis=== | ||
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==Management== | ==Management== | ||
{{Male urethritis treatment}} | |||
==Disposition== | ==Disposition== | ||
Latest revision as of 16:43, 23 April 2025
Background
Genitourinary infection
"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
Clinical Features
Chlamydia trachomatis on male GU exam consistent with urethritis.
- 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
- Urinalysis
- Urine GC/chlamydia
- Consider M. genitalium and trichomonas testing
Diagnosis
- Typically initially a clinical diagnosis with empiric treatment
Management
Uncomplicated Infection
Treatment to cover both gonorrhea and chlamydia
Typically, treatment for both gonorrhea and chlamydia is indicated, if one entity is suspected.
Standard
- Gonorrhea
- Ceftriaxone IM x 1 (500mg if <150kg, 1g if ≥150kg)
- Chlamydia
- Doxycycline 100 mg PO BID x 7 days
Ceftriaxone contraindicated
- Gonorrhea
- Gentamicin 240 mg IM x 1 PLUS azithromycin 2 g PO x 1, OR
- Cefixime 800 mg PO x 1
- Chlamydia^
- Doxycycline 100 mg PO BID x 7 days
^Additional chlamydia coverage only needed if treated with cefixime only
Partner Treatment
- Gonorrhea
- Cefixime 800mg PO x 1
- Chlamydia
- Nonpregnant: doxycycline 100mg PO BID x 7 days, OR
- Pregnant: azithromycin 1g PO x 1
Recurrent or Persistent
Target M. genitalium
- Moxifloxacin 400 mg daily x 7 days
Consider coverage of trichomonas, among men who have sex with women
- Metronidazole 2 g PO in a single dose
- Azithromycin 1 g PO x1
Disposition
- Outpatient