Urethritis in men
Background
Genitourinary infection
"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
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
Treatment to cover both gonorrhea and chlamydia
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[1]
- 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
- Outpatient