From the Guidelines
Yes, urethritis can become chronic in males and continue to be transmitted to sexual partners for several years if left untreated or inadequately treated. Chronic urethritis typically develops when the initial infection is not completely cleared, often due to incomplete antibiotic treatment, antibiotic resistance, or reinfection 1. Common causes include Chlamydia trachomatis, Mycoplasma genitalium, Ureaplasma urealyticum, and Trichomonas vaginalis.
Causes and Transmission
The persistence of these infections occurs because many pathogens can establish biofilms or intracellular infections that shield them from the immune system and antibiotics, allowing them to persist and be transmitted during sexual contact even when symptoms are mild or absent. Asymptomatic infected men may unknowingly infect their sex partner(s) before seeking treatment 1.
Treatment and Prevention
Treatment depends on identifying the specific pathogen through testing and typically involves appropriate antibiotics such as doxycycline (100mg twice daily for 7-14 days) for chlamydia, or azithromycin (1g single dose or 500mg on day 1, then 250mg daily for days 2-5) for mycoplasma 1. It's crucial that both partners get tested and treated simultaneously to prevent reinfection, and they should abstain from sexual activity until treatment is complete and symptoms have resolved.
Complications and Follow-Up
Chronic urethritis can lead to complications like epididymitis, prostatitis, or urethral strictures if not properly addressed. Patients should be instructed to return for evaluation if symptoms persist or recur after completion of therapy, and providers should be alert to the possibility of chronic prostatitis/chronic pelvic pain syndrome in male patients experiencing persistent pain or discomfort 1. Repeat testing of all men diagnosed with chlamydia or gonorrhea is recommended 3–6 months after treatment, regardless of whether patients believe that their sex partners were treated 1.
From the Research
Urethritis Transmission and Chronicity
- Urethritis can be caused by various pathogens, including Chlamydia trachomatis and Neisseria gonorrhoeae, which can lead to chronic infection if left untreated or inadequately treated 2, 3.
- Chronic urethritis can persist for several years in males, and the infection can continue to be transmitted to sexual partners 3, 4.
- The primary goal of treatment is to alleviate symptoms, prevent complications, and reduce the transmission of the infection to sexual partners 2, 5.
Treatment and Management
- Empirical antibiotic treatments are no longer recommended, and accurate microbiological investigations using nucleic acid amplification tests (NAAT) are necessary to guide treatment 5.
- First-line treatment for gonococcal urethritis typically involves a single dose of ceftriaxone and azithromycin combined therapy 5.
- For nongonococcal urethritis, specific therapies should be initiated based on the pathogen involved, and azithromycin has been shown to be effective in eradicating Mycoplasma genitalium infections 6, 4.
- Sexual partners should be investigated and treated to prevent reinfection, and sexual abstinence is recommended for at least 7 days after treatment initiation 5.
Risk Factors and Prevention
- Various risk factors, including immunodeficiency, multiple sexual partners, and alcohol abuse, can increase the likelihood of developing urethritis 5.
- The use of condoms is strongly recommended to prevent the transmission of urethritis and other sexually transmitted infections 5.
- Accurate diagnosis and treatment, as well as education and awareness about the risks and prevention of urethritis, are essential for controlling the spread of the infection 2, 5.