From the Guidelines
Urethritis is primarily caused by sexually transmitted infections, with the most common pathogens being Neisseria gonorrhoeae and Chlamydia trachomatis. The causes of urethritis can be broken down into:
- Infectious causes, including:
- Non-infectious causes, including:
- Chemical irritants from soaps, spermicides, or lubricants
- Trauma or insertion of foreign bodies into the urethra
According to the most recent guidelines, the principal bacterial pathogens of proven clinical importance in men who have urethritis are N. gonorrhoeae and C. trachomatis 1. Testing to determine the specific etiology is recommended because both chlamydia and gonorrhea are conditions that are reportable to state health departments, and a specific diagnosis may enhance partner notification and improve compliance with treatment, especially in the exposed partner 1.
The diagnosis of urethritis can be confirmed through physical examination, urinalysis, and specific tests for causative organisms, including a Gram stain of urethral secretions demonstrating >5 WBCs per oil immersion field, or a positive leukocyte esterase test on first-void urine or microscopic examination of first-void urine demonstrating >10 WBCs per high power field 1.
Treatment depends on the specific cause, with antibiotics being the standard for bacterial infections. For gonococcal urethritis, a single dose of ceftriaxone 500mg intramuscularly is typically recommended, while non-gonococcal urethritis is often treated with doxycycline 100mg twice daily for 7 days or azithromycin 1g as a single dose. Sexual partners should also be treated to prevent reinfection, and patients should abstain from sexual activity until treatment is complete.
From the Research
Causes of Urethritis
The causes of urethritis can be classified into two main categories: gonococcal and non-gonococcal urethritis.
- Gonococcal urethritis is caused by the bacterium Neisseria gonorrhoeae 2, 3, 4, 5.
- Non-gonococcal urethritis is most commonly caused by Chlamydia trachomatis, Mycoplasma genitalium, or Trichomonas vaginalis 2, 3, 5. Other less common pathogens that can cause urethritis include:
- Ureaplasma species 5
- Adenovirus 5
- Herpes simplex virus 5
Sexually Transmitted Pathogens
Urethritis is often caused by sexually transmitted pathogens, and the incidence of several sexually transmitted infections that cause urethritis is increasing 6.
- The primary pathogens associated with urethritis are Chlamydia trachomatis and Neisseria gonorrhoeae 2, 3, 4, 5.
- Recent studies have focused on identifying causes of non-gonococcal urethritis and developing testing for atypical organisms, such as Mycoplasma genitalium and Ureaplasma species 5.
Diagnosis and Treatment
A diagnosis of urethritis can be made based on symptoms, laboratory tests, and physical examination findings 3, 5.