Urethritis in men: Difference between revisions
| Line 31: | Line 31: | ||
===Recurrent or Persistent=== | ===Recurrent or Persistent=== | ||
''Target [[M. genitalium]] | ''Target [[M. genitalium]]'' | ||
*[[Azithromycin]] 1 gm PO x 1 (if not administered in the initial regimen), '''OR''' | *[[Azithromycin]] 1 gm PO x 1 (if not administered in the initial regimen), '''OR''' | ||
*[[Moxifloxacin]] 400 mg daily x 7 days (if the initial failed regimen included azithromycin) | *[[Moxifloxacin]] 400 mg daily x 7 days (if the initial failed regimen included azithromycin) | ||
Revision as of 11:11, 31 October 2017
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
- 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
Initial antimicrobial treatment is typically empiric, depending on risk for gonococcal versus nongonococcal urethritis
Gonococcal
Will also treat chlamydia
- Ceftriaxone 250 mg IM x 1, PLUS
- Azithromycin 1 gm PO x 1
Nongonococcal
Chlamydia most likely pathogen
- Azithromycin 1 gm PO x 1, OR
- Doxycycline 100 mg 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 (if the initial failed regimen included azithromycin)
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