Urethritis is inflammation of the urethra, most often from sexually transmitted infections such as gonorrhea and chlamydia, with Mycoplasma genitalium and trichomonas as other causes. Many infected people, especially women, have no symptoms, so testing and partner treatment are key.
Key symptoms
- Burning or pain with urination
- Discharge from the urethra, clear to white or yellow-green
- Itching or irritation at the tip of the penis
- Often no symptoms at all
What you find on exam
- Urethral discharge, gently milking the shaft if needed
- Look for ulcers, warts and enlarged groin nodes
- Check the testes and epididymis for tenderness; pelvic exam in women for cervicitis
- Joint, eye and skin signs of reactive arthritis or spread gonorrhea
Tests
- NAAT for gonorrhea and chlamydia on first-catch urine or a swab
- Gram stain of discharge if available: white cells with gram-negative diplococci
- Mycoplasma genitalium and trichomonas testing if symptoms persist
- Offer HIV, syphilis and hepatitis testing; pregnancy test when relevant
Treatment basics
- Gonorrhea: ceftriaxone 500 mg IM once, 1 g if 150 kg or more
- Chlamydia: doxycycline 100 mg twice daily for 7 days; azithromycin in pregnancy
- Treat recent partners, with expedited partner therapy where allowed
- No sex until 7 days after treatment and symptoms are gone
- Retest for reinfection at 3 months
Red flags
- Fever, rash and joint pain (disseminated gonococcal infection)
- Painful, swollen testicle (epididymitis)
- Red eyes with joint pain (reactive arthritis)
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.