Urethritis in men

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
  • Pyelonephritis
    • Emphysematous pyelonephritis
  • Renal abscess
  • Perinephric abscess
• 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

Management

Initial antimicrobial treatment is typically empiric, depending on risk for gonococcal versus nongonococcal urethritis

Gonococcal

Will also treat chlamydia

• Ceftriaxone 250 mg IM x 1, PLUS
• Azithromycin 1 gm PO x 1

Nongonococcal

Chlamydia most likely pathogen

• Azithromycin 1 gm PO x 1, OR
• Doxycycline 100 mg PO BID x 7 days

Recurrent or Persistent

Target M. genitalium, a common cause of persistent nongonococcal urethritis

• Azithromycin 1 gm) PO x 1 (if not administered in the initial regimen), OR
• Moxifloxacin 400 mg daily x 7 days (if the initial failed regimen included azithromycin)

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

See Also

• STIs
• Urinary tract infections