Materiały źródłowe

• #1 Urethritis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK537282/

  Urethritis is a lower urinary tract infection that causes inflammation of the urethra, the fibromuscular tube responsible for expelling urine from the body in both males and females. Urethritis is commonly associated with sexually transmitted infections (STIs) and is classified as either gonococcal or nongonococcal. Diagnosis depends on a comprehensive patient history, physical examination, and appropriate laboratory tests to confirm the presence of infection. Testing and treatment are crucial to prevent the spread of STIs. The most common symptom of urethritis is urethral discharge. Urethritis is diagnosed based on any of the following signs or laboratory tests: Urethral mucopurulent or purulent discharge. Gram stain of urethral secretions revealing 2 or more white blood cells (WBCs) per oil immersion field. A positive leukocyte esterase test on first-void urine or a microscopic examination of first-void urine sediment reveals 10 or more WBCs per high-power field. Utilization of nucleic acid amplification testing (NAAT). A diagnosis of urethritis is typically established based on examination revealing evidence of any of the following: Mucopurulent or purulent discharge from the urethral meatus. Detection of 2 or more WBCs per oil immersion field from a gram stain of a urethral swab. Positive leukocyte esterase and/or the presence of 10 or more WBCs per high-power field of the first-voided urine in the absence of a UTI. All patients diagnosed with urethritis should undergo testing for C trachomatis and N gonorrhoeae. The preferred method is typically NAAT performed on a first-voided urine sample, endourethral swab, or endocervical sample. Urethritis is primarily diagnosed based on clinical assessment, medical history, and physical examination.

• #1 Diagnosis and Treatment of Urethritis in Men | AAFP

  https://www.aafp.org/pubs/afp/issues/2010/0401/p873.html

  Symptoms of urethritis in men typically include urethral discharge, penile itching or tingling, and dysuria. A diagnosis 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. […] The goals of treatment are to alleviate symptoms, prevent complications, reduce transmission of coinfections (particularly human immunodeficiency virus [HIV]), identify and treat contacts, and encourage behavioral changes to reduce the risk of recurrence. […] Currently, urethritis is diagnosed by at least one of the following: the presence of urethral discharge, a positive leukocyte esterase test result in first-void urine, or at least 10 white blood cells per high-power field in first-void urine sediment.

• #1 Urethritis: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/22858-urethritis

  Urethritis is an inflammation (swelling and irritation) of the urethra, the tube that takes urine (pee) from your bladder to the outside of your body. Typically, urethritis is caused by an infection. Most commonly, but not always, the cause is a sexually transmitted infection (STI). […] Your healthcare provider will take a medical history and ask you questions, some of them about your sexual history. They will also do a physical examination to check for redness or discoloration, swelling and pain. […] Your provider may order tests that may include: Lab tests of discharge. Blood tests. Urine tests. These tests may help your provider diagnose urethritis and the type of infection causing it. […] Antibiotics are the main treatment for urethritis, either alone or in combination. Some of the antibiotics used to treat urethritis include: Azithromycin. Doxycycline. Ofloxacin. Levofloxacin. Ceftriaxone. Cefixime.

• #1 Urethritis: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000439.htm

  Urethritis is inflammation (swelling and irritation) of the urethra. The health care provider will examine you. In men, the exam will include the abdomen, bladder area, penis, and scrotum. Women will have abdominal and pelvic exams. The following tests may be done: Complete blood count (CBC), C-reactive protein test, Cystoscopy (examination of the urethra and bladder with a camera), Pelvic ultrasound (women only), Pregnancy test (women only), Urinalysis and urine cultures, Tests for gonorrhea, chlamydia, and other sexually transmitted illnesses (STI), Urethral swab. The goals of treatment are to: Get rid of the cause of infection, Improve symptoms, Prevent the spread of infection. With the correct diagnosis and treatment, urethritis most often clears up without further problems. […] Contact your provider if you have symptoms of urethritis.

• #1 Urethritis Workup: Laboratory Studies, Imaging Studies, Procedures

  https://emedicine.medscape.com/article/438091-workup

  Previously, urethritis was diagnosed based on Gram stain of urethral discharge demonstrating 5 white blood cells (WBC) per high power field (hpf). More recent studies suggest that utilizing a threshold of 5 WBC hpf could miss a significant proportion of infections due to Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma genitalium. According to the current Centers for Disease Control and Prevention (CDC) guidelines, urethritis can be documented on the basis of any of the following signs or laboratory test results: Mucoid, mucopurulent, or purulent discharge on examination […] Gram stain of urethral secretions demonstrating 2 WBC per oil immersion field on microscopy […] The microscopy diagnostic cutoff might vary, depending on background prevalence (2 WBCs/high power field [HPF] in high-prevalence settings [STI clinics] or 5 WBCs/HPF in lower-prevalence settings) […] Positive leukocyte esterace test from a first-void urine […] Microscopic examination of sediment from a spun first-void urine demonstrating 10 WBC/hpf. All patients with urethritis should be tested for N gonorrhoeae and C trachomatis. M. genitalium testing should be performed for men who have persistent or recurrent symptoms after initial empiric treatment. Testing for T. vaginalis should be considered in areas or among populations with high prevalence, in cases where a partner is known to be infected, or for men who have persistent or recurrent symptoms after initial empiric treatment.

• #1 Diagnosis and Treatment of Urethritis in Men | AAFP

  https://www.aafp.org/pubs/afp/issues/2010/0401/p873.html

  If urethritis or STI risk factors are present, blood testing for syphilis, HIV, and hepatitis B should be offered because coinfection is common. Testing for urethral pathogens other than N. gonorrhoeae and Chlamydia is controversial, and is generally reserved for patients with resistant or recurrent unexplained symptoms. […] In patients with confirmed urethritis, concurrent treatment for gonorrhea and chlamydia is recommended unless test results are already known or rapid results can be obtained to narrow treatment. Current CDC recommendations for these infections are listed in Table 2. […] Men returning for evaluation of persistent or recurrent urethral symptoms can be challenging to diagnose and treat. Considerations include a recurrent infection, usually because of a lack of simultaneous treatment of partners or reinfection by a new partner; an untreated infection, such as Mycoplasma, Ureaplasma, Trichomonas, HSV, Enterobacteriaceae, or adenovirus; a resistant organism; or a noninfectious cause.

• #1 Urethritis Workup: Laboratory Studies, Imaging Studies, Procedures

  https://emedicine.medscape.com/article/438091-workup

  Traditionally, treatment was based on Gram stain results. Patients with gram-negative intracellular diplococci on urethral smear received treatment for gonococcal urethritis, and those without gram-negative intracellular diplococci received treatment for nongonococcal urethritis (NGU). Because current recommendations suggest concomitant treatment for both, and with the success of nucleic acid amplification tests (NAATs), a Gram stain may be unnecessary. Of note, the sensitivity of urethral Gram stain is highly dependent on the method of collection and the experience of the provider. A negative Gram stain does not rule out gonococcal urethritis. […] Endourethral culture (obtained by gently inserting a malleable cotton-tipped swab 1-2 cm into the urethra), rather than culture of the expressible discharge, is necessary to test for C trachomatis infection. This culture may be a useful screening tool for penicillinase-producing N gonorrhoeae or chromosomally mediated resistance to multiple antibiotics. However, the results do not influence the initial antibiotic therapy, and performing this screening may not be cost-effective. Cultures for N gonorrhoeae should be obtained in cases of sexual assault, developing antimicrobial resistance, or suspected gonorrhea treatment failures.

• #1 Urethritis differential diagnosis – wikidoc

  https://www.wikidoc.org/index.php/Urethritis_differential_diagnosis

  Urethritis presents with urinary irritative symptoms and urethral discharge. Differential diagnosis is based on gender and chronicity of symptoms. […] Urethritis must be differentiated from other diseases that cause lower urinary tract irritation symptoms (e.g., dysuria, urgency and frequency in addition to urethral discharge); these include cystitis, cervicitis, vulvovaginitis, epididymitis, prostatitis, and syphilis. […] The following table summarizes the differential diagnosis for urethritis. […] Urethritis: + + + Urethral discharge + […] Positive leukocyte esterase test or 10 WBCs […] Gram stain mucoid or purulent discharge […] Tender and enlarged prostate in acute prostatitis […] Tender and soft (boggy) prostate in chronic prostatitis […] A prostate massage should never be done in a patient with suspected acute prostatitis, since it may induce sepsis. […] Cervicitis: + + + Cervical Endocervical exudate Culture for gonococcal cervicitis […] 10 WBC in vaginal fluid, in the absence of trichomoniasis, may indicate endocervical inflammation caused specifically by C. trachomatis or N. gonorrhea.

• #1 Urethritis Workup: Laboratory Studies, Imaging Studies, Procedures

  https://emedicine.medscape.com/article/438091-workup

  Urinalysis is not a useful test in patients with urethritis, except for helping exclude cystitis or pyelonephritis, which may be necessary in cases of dysuria without discharge. Patients with gonococcal urethritis may have leukocytes in a first-void urine specimen and fewer or none in a midstream specimen. More than 30% of patients with NGU do not have leukocytes in urine specimens. Many nucleic acid-based tests for C trachomatis and N gonorrhoeae can be performed on urine specimens. These require a first-voided specimen. For Chlamydia species, endourethral samples are more accurate. […] Polymerase chain reaction (PCR) assays are available for gonococcal urethritis and Chlamydia infection. NAATs are also available for Mycoplasma species, Ureaplasma species, and Trichomonas vaginalis, but these are not recommended, as they are expensive and do not alter the choice of treatment. NAATs are the preferred test for both C trachomatis and N gonorrhoeae due to their higher sensitivity and specificity. NAATs can be performed on urethral swabs or first-void urine samples. In males, first-void urine is the preferred specimen for NAATs. To prevent false-negative findings, obtain urethral swabs at least 2 hours after micturition using a calcium-alginate swab on a non-wooden stick inserted at least 1 cm in depth. If patients meet diagnostic criteria for urethritis, but Gram stain is unavailable or inconclusive, administer NAAT testing for C trachomatis and N gonorrhoeae.

• #1 Urethritis – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/54

  Urethritis classically presents as acute urethral discharge following unprotected sex. […] The two most important etiologic agents are Neisseria gonorrhoeae and Chlamydia trachomatis. […] Urethritis is usually a sexually transmitted infection that typically presents with dysuria, urethral discharge, and/or pruritus at the end of the urethra. Urethral discharge is the classic physical finding. If the urinalysis is positive for leukocyte esterase, the Gram stain of the discharge (2 white blood cells per oil immersion field) or sediment of the first-voided urine (10 white blood cells per high power field) reveals abnormal numbers of polymorphonuclear leukocytes, the diagnosis of urethritis is confirmed. […] Urethritis is divided into 2 main categories: gonococcal, if Neisseria gonorrhoeae is isolated; nongonococcal (NGU), if N gonorrhoeae is not isolated.

• #1 Urethritis and Cervicitis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/urethritis-and-cervicitis.htm

  Clinicians should attempt to obtain objective evidence of urethral inflammation. If POC diagnostic tests (e.g., Gram stain or MB or GV microscopy) are unavailable, urethritis can be documented on the basis of any of the following signs or laboratory tests: Mucoid, mucopurulent, or purulent discharge on examination. […] Men evaluated in settings in which Gram stain or MB or GV smear is unavailable who meet at least one criterion for urethritis (i.e., urethral discharge, positive leukocyte esterase test on first void urine, or microscopic examination of first-void urine sediment with 10 WBCs/HPF) should be tested for C. trachomatis and N. gonorrhoeae by NAATs and treated with regimens effective against gonorrhea and chlamydia. […] If symptoms are present but no evidence of urethral inflammation is present, NAATs for C. trachomatis and N. gonorrhoeae might identify infections. Persons with chlamydia or gonorrhea should receive recommended treatment, and sex partners should be referred for evaluation and treatment.

• #1 Urethritis in Females and Males: Healing Urethra Pain

  https://www.verywellhealth.com/urethritis-7965973

  Urethritis is the inflammation of the urethra (the tube through which urine exits the body). […] It can sometimes be difficult to know if you have urethritis or some other medical condition and whether you need antibiotics or can wait for the condition to clear on its own. […] This article looks at the symptoms of urethritis in females and males, including how the condition is diagnosed, treated, and prevented. […] Because of this, urethritis in females will frequently co-occur with cervicitis (inflammation of the cervix), particularly when gonorrhea or chlamydia are involved. […] Even so, urethritis in females is often asymptomatic (meaning without symptoms) and may go unnoticed until serious complications develop. […] Males are more likely than females to experience symptoms of urethritis.

• #1 Urethritis in Females and Males: Healing Urethra Pain

  https://www.verywellhealth.com/urethritis-7965973

  Urethritis in males often co-occurs with proctitis (inflammation of the rectum). […] Because of this, it is important to see a healthcare provider to confirm you have urethritis and pinpoint the exact cause. […] The diagnosis will start with a review of your medical history, including recent sexual contacts. […] If urethritis is suspected, a swab of fluid will be taken from the urethra. […] A microscopic examination of the sample can establish whether gonococcal urethritis or NGU is the most likely cause. […] With few exceptions, urethritis doesn’t heal on its own and will require medical treatment to clear the underlying infection. […] Even if the bacterial cause is not confirmed, an NGU will generally be treated with one of the following three antibiotic regimens: Doxycycline, Azithromycin.

• #1 Diagnosis and treatment outcomes of urethritis-like symptoms in young males: a retrospective cohort study | Scientific Reports

  https://www.nature.com/articles/s41598-023-44733-z

  The study evaluated the prevalence of gonorrhoea and chlamydia infections and find out other non-infectious diseases in sexually active young males with urethritis-like symptoms and their treatment outcomes. […] All patients underwent urinalysis, urine culture, and urinary polymerase chain reaction (PCR) testing for gonorrhoea and chlamydia. […] Urethral discharge was an independent predictor. […] Empirical antibiotic treatment is recommended for patients with urethritis symptoms showing positive or negative urinalysis results but with urethral discharge. […] The present study aimed to investigate the prevalence of gonorrhoea and chlamydia infections and find out other non-infectious diseases in patients presenting with urethritis symptoms. […] Diagnosis is therefore mainly based on exclusion.

• #1 Urethritis: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/22858-urethritis

  If you have urethritis and you’re treated with the correct medication, you should be cured entirely. It’s important to note that your sexual partners must also take the medication. If only one of you is treated, you can continue to pass the infection back and forth. […] If you’ve been diagnosed with urethritis, call your provider if: You aren’t feeling any better even though you’ve followed directions about taking your medication. You feel like you’re getting worse. You’ve developed new signs or symptoms that are worrying you. You’re having a bad reaction to your medication. […] If you are feeling pain when you pee, or itchiness, you may have urethritis. This diagnosis is more likely if you’re sexually active and if you’ve had unprotected sex. You should make an appointment with your healthcare provider. Your provider will ask you questions about your sex life. It’s important to be honest with your provider about your sexual activity so they can provide the best diagnosis and treatment. Urethritis can be cured.

• #2 Urethritis – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/54

  Urethritis classically presents as acute urethral discharge following unprotected sex. […] The two most important etiologic agents are Neisseria gonorrhoeae and Chlamydia trachomatis. […] Urethritis is usually a sexually transmitted infection that typically presents with dysuria, urethral discharge, and/or pruritus at the end of the urethra. Urethral discharge is the classic physical finding. If the urinalysis is positive for leukocyte esterase, the Gram stain of the discharge (2 white blood cells per oil immersion field) or sediment of the first-voided urine (10 white blood cells per high power field) reveals abnormal numbers of polymorphonuclear leukocytes, the diagnosis of urethritis is confirmed. […] Urethritis is divided into 2 main categories: gonococcal, if Neisseria gonorrhoeae is isolated; nongonococcal (NGU), if N gonorrhoeae is not isolated.

• #2 Urethritis: Rapid Evidence Review | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/0501/p553.html

  Urethritis refers to inflammation of the urethra and is classified as gonococcal (caused by Neisseria gonorrhoeae) or nongonococcal in origin (most commonly caused by Chlamydia trachomatis, Mycoplasma genitalium, or Trichomonas vaginalis). The most common signs and symptoms include dysuria, mucopurulent urethral discharge, urethral discomfort, and erythema. Diagnostic criteria include typical signs, symptoms, or history of exposure in addition to mucopurulent discharge, Gram stain of urethral secretions showing at least two white blood cells per oil immersion field, first-void urinalysis showing at least 10 white blood cells per high-power field, or a positive leukocyte esterase result with first-void urine. […] Urethritis should be suspected based on the presence of typical signs and symptoms, such as dysuria, urethral discharge, or urethral erythema.

• #2 Urethritis

  https://www.nhs.uk/conditions/urethritis/

  Urethritis is when the tube that carries pee from the bladder out of the body (urethra) becomes swollen and sore. It’s often caused by a sexually transmitted infection (STI). It’s important to get it treated to avoid it spreading to other people. […] If you think you might have urethritis or a sexually transmitted infection (STI), go to a sexual health clinic or see a GP. […] If you have symptoms of urethritis, you may have a swab test a cotton bud takes a sample from the urethra (this can feel uncomfortable for a few seconds) or a urine test you’ll be asked not to pee for at least 2 hours before giving a urine sample as this can help make the results more reliable. […] If the test shows that you have urethritis, anyone you’ve had sex with recently should be contacted and asked to get tested and treated if needed.

• #2

  https://www.beaumont.org/conditions/urethritis

  If you are experiencing painful urination or vaginal or urethral discharge, your doctor may assume an infection is present and may prescribe antibiotics immediately while awaiting test results. […] Tests can help confirm the diagnosis of urethritis and its cause and can include: […] physical examination of the genitals, abdomen and rectum to check for discharge and tenderness. […] urine tests for gonorrhea, chlamydia or other bacteria. […] examination of any discharge under a microscope. […] Blood tests are sometimes performed, but are not often necessary for an accurate diagnosis.

• #2 Non-specific urethritis (NSU)

  https://www.healthywa.wa.gov.au/Articles/N_R/Non-specific-urethritis-NSU

  If NSU is suspected, a urine sample and/or swab is taken from the urethra. The samples will be tested in a laboratory. […] Its a good idea to have tests for other sexually transmitted infections (STIs) at the same time.

• #2 Urethritis and Cervicitis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/urethritis-and-cervicitis.htm

  Urethritis, as characterized by urethral inflammation, can result from either infectious or noninfectious conditions. Symptoms, if present, include dysuria, urethral pruritis, and mucoid, mucopurulent, or purulent discharge. Signs of urethral discharge on examination can also be present among persons without symptoms. […] If POC diagnostic tools (e.g., Gram, methylene blue [MB], or gentian violet [GV] stain microscopy) are unavailable, drug regimens effective against both gonorrhea and chlamydia should be administered. Further testing to determine the specific etiology is recommended for preventing complications, reinfection, and transmission because a specific diagnosis might improve treatment compliance, delivery of risk-reduction interventions, and partner services. […] NAATs are preferred for detecting C. trachomatis and N. gonorrhoeae, and urine is the preferred specimen for males.

• #2 Urethritis Workup: Laboratory Studies, Imaging Studies, Procedures

  https://emedicine.medscape.com/article/438091-workup

  Traditionally, treatment was based on Gram stain results. Patients with gram-negative intracellular diplococci on urethral smear received treatment for gonococcal urethritis, and those without gram-negative intracellular diplococci received treatment for nongonococcal urethritis (NGU). Because current recommendations suggest concomitant treatment for both, and with the success of nucleic acid amplification tests (NAATs), a Gram stain may be unnecessary. Of note, the sensitivity of urethral Gram stain is highly dependent on the method of collection and the experience of the provider. A negative Gram stain does not rule out gonococcal urethritis. […] Endourethral culture (obtained by gently inserting a malleable cotton-tipped swab 1-2 cm into the urethra), rather than culture of the expressible discharge, is necessary to test for C trachomatis infection. This culture may be a useful screening tool for penicillinase-producing N gonorrhoeae or chromosomally mediated resistance to multiple antibiotics. However, the results do not influence the initial antibiotic therapy, and performing this screening may not be cost-effective. Cultures for N gonorrhoeae should be obtained in cases of sexual assault, developing antimicrobial resistance, or suspected gonorrhea treatment failures.

• #2 Urethritis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/30837

  A diagnosis of urethritis is typically established based on examination revealing evidence of any of the following: Mucopurulent or purulent discharge from the urethral meatus. […] Detection of 2 or more WBCs per oil immersion field from a gram stain of a urethral swab. […] Positive leukocyte esterase and/or the presence of 10 or more WBCs per high-power field of the first-voided urine in the absence of a UTI. […] Urinalysis alone is not diagnostic for urethritis, although the first voided urine sample can be utilized for testing such as NAATs and cultures. Urinalysis can help identify or rule out a UTI. Notably, over 30% of patients with nongonococcal urethritis may not exhibit WBCs in their urine. […] Gram-negative intracellular diplococci observed on microscopic examination of the discharge or a positive methylene blue/gentian violet (MB/GV) smear typically indicate gonococcal urethritis. In the absence of such findings, it is classified as nongonococcal urethritis.

• #2 Urethritis – Symptoms, Types, Causes & Diagnosis

  https://www.ganeshdiagnostic.com/blog/urethritis-symptoms-types-causes-and-diagnosis

  A urinary tract infection and urethritis are not the same things (UTI). A UTI is an infection of the urinary system, whereas urethritis is an inflammation of the urethra. While sharing some symptoms, they might need to be treated using a different approach depending on what caused their urethritis in the first place. […] Today, urethritis is a common condition that can be caused by a variety of factors, including bacterial and viral infections, trauma, and certain medical procedures. It is typically treated with antibiotics, and preventive measures such as practising safe sex and maintaining good hygiene can help reduce the risk of developing the condition. […] To diagnose urethritis, a doctor will typically perform a physical exam and ask about the patient’s symptoms and medical history. They may also perform tests, such as a urine test or a swab of the urethra, to check for the presence of bacteria, viruses, or other pathogens.

• #2 Diagnosis of urethritis – GPnotebook

  https://gpnotebook.com/pages/infectious-disease/gonorrhoea/diagnosis-of-urethritis

  Diagnosis of urethritis is supported by clinical symptoms (dysuria, urethral irritation, or meatal pruritus) and/or presence of a visible discharge or presence of balano-posthitis (1). […] The diagnosis of urethritis should be confirmed by microscopy of either a urethral swab or first-void urine sample. […] All patients with should be tested both for Chlamydia and Gonorrhoea. […] If available, testing male patients with urethritis for M. genitalium should be performed (1,2). […] In case of suspected UTI (e.g. – severe dysuria, haematuria (microscopic or macroscopic), nocturia, urinary frequency, urgency) or if the patient is at low risk for a sexually transmitted infection, a urinary dipstick analysis on a mid-stream urine (MSU) specimen should be considered and a MSU sample should be sent for culture and sensitivity (2). […] First-void urine is the specimen of choice for NAATs (2).

• #2 Male Chlamydial Urethritis: Causes, Symptoms, and Diagnosis

  https://www.healthline.com/health/std/chlamydial-urethritis-male

  Chlamydial urethritis in men is an infection of the urethra caused by the sexually transmitted disease (STD) chlamydia. […] Your doctor will perform a series of lab tests to diagnose chlamydial urethritis. You’ll be asked to give a urine sample, which will be tested for the presence of the chlamydia organism. […] You may also need a urethral discharge culture, or swab test, to rule out gonorrhea. […] A technician will swab the head of your penis with alcohol or another sterile agent. Next, the technician or your doctor will insert a cotton swab into your urethra at the tip of your penis. The discharge or fluids collected will be analyzed to determine the cause of your infection.

• #2 Urethritis Workup: Laboratory Studies, Imaging Studies, Procedures

  https://emedicine.medscape.com/article/438091-workup

  The following additional tests may be considered: Potassium hydroxide (KOH) preparation: This is used to evaluate for fungal organisms […] Wet preparation: Secretions reveal the movement of trichomonal organisms, if present […] Sexually transmitted disease (STD) testing: Patients with urethritis should be counseled about the risk for more serious STDs and should be offered syphilis serology (Venereal Disease Research Laboratory [VDRL] test or Rapid Plasma Reagin [RPR] test) and HIV serology. Men who receive a diagnosis of NGU should be tested for HIV and syphilis […] Nasopharyngeal and/or rectal swabs: Men who have sex with men (and perhaps other patients) should undergo gonorrhea screening with nasopharyngeal and/or rectal swabs; validation of NAATs for these specimens is still in progress.

• #2 Urethritis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK537282/

  Urethritis is a lower urinary tract infection that causes inflammation of the urethra, the fibromuscular tube responsible for expelling urine from the body in both males and females. Urethritis is commonly associated with sexually transmitted infections (STIs) and is classified as either gonococcal or nongonococcal. Diagnosis depends on a comprehensive patient history, physical examination, and appropriate laboratory tests to confirm the presence of infection. Testing and treatment are crucial to prevent the spread of STIs. The most common symptom of urethritis is urethral discharge. Urethritis is diagnosed based on any of the following signs or laboratory tests: Urethral mucopurulent or purulent discharge. Gram stain of urethral secretions revealing 2 or more white blood cells (WBCs) per oil immersion field. A positive leukocyte esterase test on first-void urine or a microscopic examination of first-void urine sediment reveals 10 or more WBCs per high-power field. Utilization of nucleic acid amplification testing (NAAT). A diagnosis of urethritis is typically established based on examination revealing evidence of any of the following: Mucopurulent or purulent discharge from the urethral meatus. Detection of 2 or more WBCs per oil immersion field from a gram stain of a urethral swab. Positive leukocyte esterase and/or the presence of 10 or more WBCs per high-power field of the first-voided urine in the absence of a UTI. All patients diagnosed with urethritis should undergo testing for C trachomatis and N gonorrhoeae. The preferred method is typically NAAT performed on a first-voided urine sample, endourethral swab, or endocervical sample. Urethritis is primarily diagnosed based on clinical assessment, medical history, and physical examination.

• #2 Management of non-gonococcal urethritis | BMC Infectious Diseases | Full Text

  https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-015-1043-4

  Non-gonococcal urethritis (NGU), or inflammation of the urethra, is the most common treatable sexually transmitted syndrome in men, with approximately 20-50 % of cases being due to infection with Chlamydia trachomatis and 10-30 % Mycoplasma genitalium. […] The diagnosis of urethritis is confirmed by demonstrating an excess of polymorpho-nuclear leucocytes (PMNLs) in a stained smear. […] In patients presenting with symptoms of urethritis, the diagnosis should be confirmed by microscopy of a stained smear, ruling out gonorrhea. […] All cases of urethritis should be screened for C. trachomatis by NAAT on first void urine. N. gonorrhoeae must be ruled out with urethral smear microscopy, NAAT and culture. […] The first void urine should not contain more than 10 ml, a higher volume will decrease the sensitivity.

• #2 Diagnosis and treatment outcomes of urethritis-like symptoms in young males: a retrospective cohort study | Scientific Reports

  https://www.nature.com/articles/s41598-023-44733-z

  The findings of the present study will be helpful for urologists in treating young patients with symptoms of urethritis. […] The results further highlighted the high frequency of negative urinalysis and urine culture results in young male patients with gonorrhoea- and chlamydia-related urethritis and indicated the importance of urethral discharge as an indicator for antibiotic treatment of gonorrhoea and chlamydia in these patients. […] These findings will be of value for urologists treating young males with urethritis symptoms, and the insights provided in this study will facilitate appropriate management and patient satisfaction in such cases. […] The presence of discharge was independently associated with PCR positive results for gonorrhoea or chlamydia and could be a guide to prescribe antibiotics against gonorrhoea and chlamydia in clinical practice, in the absence of PCR testing ability.

• #2 Urethritis in Women | Saint Luke’s Health System

  https://www.saintlukeskc.org/health-library/urethritis-women

  Urethritis can be caused by a bacterial or viral infection. This kind of infection can lead to conditions such as a urinary tract infection (UTI) or sexually transmitted infection (STI). […] How is urethritis diagnosed? Your healthcare provider will examine you and ask about your symptoms and health history. You may also have one or more of the following tests: […] Urine test. Urine samples are taken and checked for problems. […] Blood test. A blood sample is taken and checked for problems. […] Vaginal culture. A sample of vaginal discharge is taken and tested for problems. A cotton swab is inserted into the vagina. […] Cystoscopy. This test lets the provider look for problems in the urinary tract. The test uses a thin, flexible telescope called a cystoscope with a light and camera attached. The scope is put into the urethra. […] Nucleic acid test (NAT). This can tell if you have a virus or bacteria. It may be done instead of a culture because it allows for a faster diagnosis.

• #2 Diagnosis and treatment outcomes of urethritis-like symptoms in young males: a retrospective cohort study | Scientific Reports

  https://www.nature.com/articles/s41598-023-44733-z

  Based on the findings of the present study, we have provided a flowchart for the management of young male patients with urethritis-like symptoms. […] Empirical antibiotics including ceftriaxone, azithromycin and doxycycline should be considered in patients with a history of urethral discharge despite of no pyuria on urinalysis at visit. […] The prognosis of urethritis-like symptoms was quite good even when a pathogen could not be identified. […] Urologists should provide empirical treatment based on their clinical judgment and help relieve their anxiety through reassurance.

• #2 Management of non-gonococcal urethritis | BMC Infectious Diseases | Full Text

  https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-015-1043-4

  Treatment without etiological diagnosis or verifying the presence of urethritis is not recommended. […] In patients presenting with symptoms of urethritis, the diagnosis should be confirmed by microscopy in order to demonstrate an excess of PMNLs in a stained smear and rule out gonorrhoea. […] Detection of N. gonorrhoeae, C. trachomatis and for M. genitalium using a NAAT is indicated in all patients. […] Persistent or recurrent NGU must be confirmed with microscopy. […] The following treatment options are based on clinical experience and expert opinion. If doxycycline was given as first line therapy, azithromycin 1.5 grams over five days plus metronidazole 4500 mg twice daily for 57 days should be given. If azithromycin was prescribed as first line therapy, doxycycline 100 mg x 2 for one week plus metronidazole should be given. […] Moxifloxacin 400 mg orally once daily for 714 days can be used if macrolide resistant M. genitalium infection is suspected.

• #2 Diagnosis and Treatment of Urethritis in Men | AAFP

  https://www.aafp.org/pubs/afp/issues/2010/0401/p873.html

  If urethritis or STI risk factors are present, blood testing for syphilis, HIV, and hepatitis B should be offered because coinfection is common. Testing for urethral pathogens other than N. gonorrhoeae and Chlamydia is controversial, and is generally reserved for patients with resistant or recurrent unexplained symptoms. […] In patients with confirmed urethritis, concurrent treatment for gonorrhea and chlamydia is recommended unless test results are already known or rapid results can be obtained to narrow treatment. Current CDC recommendations for these infections are listed in Table 2. […] Men returning for evaluation of persistent or recurrent urethral symptoms can be challenging to diagnose and treat. Considerations include a recurrent infection, usually because of a lack of simultaneous treatment of partners or reinfection by a new partner; an untreated infection, such as Mycoplasma, Ureaplasma, Trichomonas, HSV, Enterobacteriaceae, or adenovirus; a resistant organism; or a noninfectious cause.

• #2 Urethritis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/30837

  All patients diagnosed with urethritis should undergo testing for C trachomatis and N gonorrhoeae. The preferred method is typically NAAT performed on a first-voided urine sample, endourethral swab, or endocervical sample. Additionally, NAAT for T vaginalis should be considered, as well as testing for M genitalium if available.

• #3 Urethritis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/30837

  Urethritis is diagnosed based on any of the following signs or laboratory tests: Urethral mucopurulent or purulent discharge. […] Gram stain of urethral secretions revealing 2 or more white blood cells (WBCs) per oil immersion field. Gram stain is the preferred rapid diagnostic test for the initial assessment of urethritis, offering high sensitivity and specificity in documenting both urethritis and the presence (or absence) of gonococcal infections. […] A positive leukocyte esterase test on first-void urine or a microscopic examination of first-void urine sediment reveals 10 or more WBCs per high-power field. […] Utilization of nucleic acid amplification testing (NAAT). […] Urethritis is suspected clinically when any sexually active patient presents with symptoms such as urethral pruritus, discharge, or dysuria. Urethritis is primarily diagnosed based on clinical assessment, medical history, and physical examination. However, specific diagnostic laboratory tests are used for a more precise diagnosis.

• #3 Urethritis Workup: Laboratory Studies, Imaging Studies, Procedures

  https://emedicine.medscape.com/article/438091-workup

  Urinalysis is not a useful test in patients with urethritis, except for helping exclude cystitis or pyelonephritis, which may be necessary in cases of dysuria without discharge. Patients with gonococcal urethritis may have leukocytes in a first-void urine specimen and fewer or none in a midstream specimen. More than 30% of patients with NGU do not have leukocytes in urine specimens. Many nucleic acid-based tests for C trachomatis and N gonorrhoeae can be performed on urine specimens. These require a first-voided specimen. For Chlamydia species, endourethral samples are more accurate. […] Polymerase chain reaction (PCR) assays are available for gonococcal urethritis and Chlamydia infection. NAATs are also available for Mycoplasma species, Ureaplasma species, and Trichomonas vaginalis, but these are not recommended, as they are expensive and do not alter the choice of treatment. NAATs are the preferred test for both C trachomatis and N gonorrhoeae due to their higher sensitivity and specificity. NAATs can be performed on urethral swabs or first-void urine samples. In males, first-void urine is the preferred specimen for NAATs. To prevent false-negative findings, obtain urethral swabs at least 2 hours after micturition using a calcium-alginate swab on a non-wooden stick inserted at least 1 cm in depth. If patients meet diagnostic criteria for urethritis, but Gram stain is unavailable or inconclusive, administer NAAT testing for C trachomatis and N gonorrhoeae.

• #3 Urethritis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/30837

  A diagnosis of urethritis is typically established based on examination revealing evidence of any of the following: Mucopurulent or purulent discharge from the urethral meatus. […] Detection of 2 or more WBCs per oil immersion field from a gram stain of a urethral swab. […] Positive leukocyte esterase and/or the presence of 10 or more WBCs per high-power field of the first-voided urine in the absence of a UTI. […] Urinalysis alone is not diagnostic for urethritis, although the first voided urine sample can be utilized for testing such as NAATs and cultures. Urinalysis can help identify or rule out a UTI. Notably, over 30% of patients with nongonococcal urethritis may not exhibit WBCs in their urine. […] Gram-negative intracellular diplococci observed on microscopic examination of the discharge or a positive methylene blue/gentian violet (MB/GV) smear typically indicate gonococcal urethritis. In the absence of such findings, it is classified as nongonococcal urethritis.

• #3 Urethritis – penile | STI Guidelines Australia

  https://sti.guidelines.org.au/syndromes/urethritis-penile/

  Urethral discharge and dysuria are typical symptoms of penile urethritis. […] Make a clinical diagnosis of gonorrhoea or non-gonococcal urethritis (NGU) and treat accordingly (see clinical presentation). […] All patients who have suspected or confirmed NGU should be tested for chlamydia, gonorrhoea and M. genitalium by using NAATs. A specific diagnosis can potentially reduce complications, re-infection and transmission. […] If omitted initially, test for M. genitalium in patients with persistent or recurrent symptoms after initial empirical treatment. […] NAAT – Nucleic acid amplification test. […] If test results are negative and symptoms persist, consider testing of FPU for herpes simplex virus (HSV), adenovirus and trichomoniasis (NAAT). […] For men who have sex with men (MSM), undertake the following additional tests: Anorectal swabs and pharyngeal swabs for chlamydia(NAAT) and gonorrhoea (NAAT). […] 100% of patients diagnosed with urethritis are treated with an appropriate antibiotic regimen.

• #3 STI-associated syndromes guide: Urethritis – Canada.ca

  https://www.canada.ca/en/public-health/services/infectious-diseases/sexual-health-sexually-transmitted-infections/canadian-guidelines/sti-associated-syndromes/urethritis.html

  Obtain first-void urine (FVU) or urethral swab for nucleic acid amplification tests (NAAT) for CT and GC, plus culture for GC (where available). […] Gram stain, when available at point of care, can help distinguish GC-urethritis from non-gonococcal urethritis and guide empiric treatment. […] The decision to treat empirically or to wait for test results should reflect the severity of the clinical condition, probability of infection, person’s risk factors for a sexually transmitted and blood-borne infection (STBBI), and person’s willingness to abstain from sex and to return for test results or follow-up. […] Test of cure (TOC) will depend on which pathogen is confirmed by laboratory testing. […] When treatment is indicated for an STI: notify, evaluate, test and treat (as appropriate) sexual partners.

• #3 Urethritis

  https://www.labsmd.com/landing/urethritis_info.php

  LabsMD offers a single test to help diagnose urethritis: Chlamydia and Gonorrhea Test. […] If you are a man and have a discharge from the penis, the discharge may be tested in the lab. If tests for STDs are negative, your provider may conclude that you have nonspecific urethritis (NSU). […] In women the diagnosis can be more difficult than in men. Urethritis almost never causes a discharge from a woman’s urethra. […] Your health care provider will examine the urethra and area around it and will get a urine sample. Your provider may also swab the urethral area and cervix. […] If lab tests show that the urethritis is caused by a treatable STD, your health care provider will prescribe an antibiotic. […] For older women the most common treatment for genital tissue thinning and dryness is estrogen.

• #3 Urethritis: Symptoms, causes, and treatment

  https://www.medicalnewstoday.com/articles/264903

  The doctor may refer a person for further tests if the samples indicate complications. […] Diagnostic tests include: blood tests, such as complete blood count (CBC) and C-reactive protein test; cystoscopy, in which a tube with a camera on the end is inserted into the bladder; pelvic ultrasound test. […] Treatment depends on the underlying cause. If a person has a bacterial infection, a doctor may prescribe an antibiotic. […] The CDC recommends treatment that can be given in a single dose to encourage adherence. […] If someone has symptoms of a UTI, such as unusual discharge or pain when urinating, it is important to talk with a doctor or visit a sexual health clinic for diagnosis and treatment. […] If symptoms or urethritis persist or recur following treatment, it may be a sign that another condition is present or that the bacteria that caused the problem is resistant to the treatment given.

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