From the Guidelines
The key infective causes of urethritis are primarily divided into gonococcal and non-gonococcal types, with Neisseria gonorrhoeae and Chlamydia trachomatis being the most common causes, as reported in the most recent guideline 1.
Causes of Urethritis
- Gonococcal urethritis is caused by Neisseria gonorrhoeae
- Non-gonococcal urethritis is most commonly caused by Chlamydia trachomatis (15-40% of cases)
- Other significant non-gonococcal pathogens include Mycoplasma genitalium, Ureaplasma urealyticum, Trichomonas vaginalis, and less commonly herpes simplex virus
- Escherichia coli and other enteric bacteria can cause urethritis, particularly in men who have sex with men
Treatment of Urethritis
- Gonococcal urethritis typically requires ceftriaxone 500mg IM as a single dose plus azithromycin 1g orally as a single dose to cover potential co-infection with chlamydia
- Non-gonococcal urethritis is typically treated with doxycycline 100mg twice daily for 7 days, or azithromycin 1g as a single dose
Prevention of Reinfection
- Partner notification and treatment are essential to prevent reinfection
- Patients should abstain from sexual activity until both they and their partners have completed treatment
Importance of Laboratory Testing
- The distinction between these pathogens is important as they require different antibiotic approaches
- Proper identification through laboratory testing helps guide appropriate therapy, as recommended in the guideline 1
From the Research
Key Infectious Causes of Urethritis
The key infectious causes of urethritis can be classified into two main categories: gonococcal and nongonococcal urethritis.
- Gonococcal urethritis is caused by Neisseria gonorrhoeae 2, 3, 4, 5.
- Nongonococcal urethritis is most commonly caused by Chlamydia trachomatis, Mycoplasma genitalium, or Trichomonas vaginalis 2, with Chlamydia trachomatis being a primary cause 3, 6, 4, 5.
- Ureaplasma urealyticum is also a cause of nongonococcal urethritis, although the cause is unknown in approximately 20 to 30 percent of cases 4, 5.
Common Signs and Symptoms
The most common signs and symptoms of urethritis include:
- Dysuria
- Mucopurulent urethral discharge
- Urethral discomfort
- Erythema 2