From the Guidelines
Yes, urethritis can become chronic and persist for several years in males, significantly impacting their quality of life. Chronic urethritis is typically defined as symptoms lasting more than 6 weeks despite appropriate treatment, and it can be caused by persistent bacterial infections, recurrent infections, or non-infectious inflammatory processes 1. The condition can be caused by various pathogens, including Chlamydia trachomatis, Mycoplasma genitalium, or Ureaplasma urealyticum, and treatment depends on the underlying cause, often including extended courses of antibiotics 1.
Key Considerations
- Chronic urethritis can lead to complications such as urethral strictures and potential fertility issues if left untreated 1.
- Comprehensive testing is necessary to identify the cause of chronic urethritis and provide appropriate treatment 1.
- Treatment options may include doxycycline, azithromycin, or moxifloxacin, depending on the specific cause of the infection 1.
- Non-infectious cases may require anti-inflammatory treatments, highlighting the importance of accurate diagnosis 1.
Diagnostic Approach
- Objective signs of urethritis, such as mucopurulent or purulent discharge, should be present before initiating antimicrobial therapy 1.
- A Gram stain of urethral secretions or a positive leukocyte esterase test on first-void urine can help document urethritis 1.
- Testing for N. gonorrhoeae and C. trachomatis is recommended if urethritis is suspected but not documented 1.
Treatment Implications
- Empiric treatment without documentation of urethritis is only recommended for high-risk patients who are unlikely to return for follow-up evaluation 1.
- Partners of patients treated empirically should be evaluated and treated accordingly 1.
- The choice of antibiotic and treatment duration should be guided by the suspected or confirmed cause of the urethritis, with consideration for potential antibiotic resistance 1.
From the Research
Urethritis in Males
- Urethritis can be caused by various pathogens, including Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, and Ureaplasma species 2, 3
- Symptoms of urethritis in men typically include urethral discharge, penile itching or tingling, and dysuria 2
- Diagnosis of urethritis can be made if at least one of the following is present: discharge, a positive result on a leukocyte esterase test in first-void urine, or at least 10 white blood cells per high-power field in urine sediment 2
Chronic Urethritis
- Chronic non-gonococcal urethritis (NGU) can persist or recur in some men, with approximately 30-35% of cases being persistent or recurrent despite adequate treatment 4
- Mycoplasma genitalium has been identified as a cause of chronic NGU, with 21% of men with persistent or recurrent NGU being infected with this pathogen 5
- Treatment of chronic NGU may require a 4 to 6 week course of tetracyclines or erythromycin, and counselling to emphasize that chronic NGU is probably a self-limited disorder may be helpful 4
- In some cases, chronic urethritis can be intractable, and chronic suppression with antimicrobials may be necessary 6
Treatment and Management
- The goals of treatment for urethritis include alleviating symptoms, preventing complications, and reducing the transmission of coinfections 2
- Treatment options for urethritis include azithromycin, doxycycline, and ceftriaxone or cefixime, with the combination of azithromycin or doxycycline plus ceftriaxone or cefixime being considered first-line empiric therapy 2, 3
- Expedited partner treatment, which involves giving patients prescriptions for partners who have not been examined by the physician, is advocated by the Centers for Disease Control and Prevention and has been approved in many states 2