Urethritis in men: Difference between revisions

Revision as of 12:22, 31 October 2017

Background

Genitourinary infection

(1) Human urinary system: (2) kidney; (3) renal pelvis; (4) ureter; (5) urinary bladder (6) urethra.
Additional structures: (7) adrenal gland; (8) renal artery and vein; (9) inferior vena cava; (10) abdominal aorta; (11) common iliac artery and vein; (12) liver; (13) large intestine; (14) pelvis.

"UTI" frequently refers specifically to acute cystitis, but may also be used as a general term for all urinary infections; use location-specific diagnosis.

Renal/perirenal
Ureteral
- Infected urolithiasis
Bladder
- Acute cystitis ("UTI")
- Chronic cystitis
Urethra/periurethra
- Urethritis
- Prostatitis

Clinical Features

Dysuria
Urethral discharge

Differential Diagnosis

Dysuria

Genitourinary infection
- Acute cystitis ("UTI")
- Pyelonephritis
- Urethritis
- Chronic cystitis
- Infected nephrolithiasis
- Prostatitis
- Epididymitis
- Renal abscess/perinephric abscess
- Emphysematous pyelonephritis
Nephrolithiasis
Urethral issue
- Urethritis
- Urolithiasis
- Urethral foreign body
- Urethral diverticulum
- Allergic reaction (contact dermatitis)
- Chemical irritation
- Urethral stricture or obstruction
- Trauma to vagina, urethra, or bladder
Gynecologic
- Vaginitis/cervicitis
- PID
- Genital herpes
- Pelvic organ prolapse
- Fistula
- Cystocele
Other
- Diverticulitis
- Interstitial cystitis
- Behavioral symptom without detectable pathology

Evaluation

Workup

UA
Urine GC/chlamydia

Diagnosis

Typically initially a clinical diagnosis with empiric treatment

Management

Uncomplicated Infection

Treatment to cover both gonorrhea and chlamydia Typically, treatment for both gonorrhea and chlamydia is indicated, if one entity is suspected.

Standard

Gonorrhea
- Ceftriaxone IM x 1 (500mg if <150kg, 1g if ≥150kg)
Chlamydia
- Doxycycline 100 mg PO BID x 7 days

Ceftriaxone contraindicated

Gonorrhea
- Gentamicin 240 mg IM x 1 PLUS azithromycin 2 g PO x 1, OR
- Cefixime 800 mg PO x 1
Chlamydia^
- Doxycycline 100 mg PO BID x 7 days

^Additional chlamydia coverage only needed if treated with cefixime only

Partner Treatment

Gonorrhea
- Cefixime 800mg PO x 1
Chlamydia
- Nonpregnant: doxycycline 100mg PO BID x 7 days, OR
- Pregnant: azithromycin 1g PO x 1

Recurrent or Persistent

Target M. genitalium

Moxifloxacin 400 mg daily x 7 days

Consider coverage of trichomonas, among men who have sex with women

Metronidazole 2 g PO in a single dose
Azithromycin 1 g PO x1

Disposition

Outpatient

References

Authors:

@@ Line 18: / Line 18: @@
 ==Management==
-''Treatment to cover both [[gonorrhea]] and [[chlamydia]]''
+{{Male urethritis treatment}}
-====Uncomplicated Infection====
-*[[Ceftriaxone]] 250mg IM once, '''PLUS'''
-**[[Azithromycin]] 1g PO once '''OR'''
-**[[Doxycycline]] 100mg PO BID x 7 days
-====Cephalosporin Allergy====
-*[[Azithromycin]] 2g PO once, '''PLUS'''
-**[[Gentamicin]] 240mg IM once<ref>[http://www.cdc.gov/std/tg2015/ CDC: 2015 Sexually Transmitted Diseases Treatment Guidelines]</ref>
-**In theory this high dose macrolide will provide treatment for both [[GC]] and [[Chlamydia]]
-====Partner treatment====
-*[[Cefixime]] 400mg PO once, '''PLUS'''
-**[[Azithromycin]] 1g PO once, '''OR'''
-**[[Doxycycline]] 100mg PO BID x 7 days
-====Recurrent or Persistent====
-''Target [[M. genitalium]]''
-*[[Moxifloxacin]] 400 mg daily x 7 days
-''Consider coverage of [[T. vaginalis]], among men who have sex with women''
-*Metronidazole 2 gm PO x 1, '''OR'''
-*Tinidazole 2 gm PO x 1
 ==Disposition==