Urethritis in men: Difference between revisions

 
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==Background==
==Background==
[[File:Prostatelead.jpg|thumb|Urethral anatomy]]
{{UTI types}}
{{UTI types}}


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==Evaluation==
==Evaluation==
===Workup===
*[[Urinalysis]]
*Urine GC/chlamydia
*Consider M. genitalium and trichomonas testing
===Diagnosis===
*Typically initially a clinical diagnosis with empiric treatment


==Management==
==Management==
''Initial antimicrobial treatment is typically empiric, depending on risk for gonococcal versus nongonococcal urethritis''
{{Male urethritis treatment}}
 
===[[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==
==Disposition==

Latest revision as of 14:58, 16 June 2021

Background

Urethral anatomy

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.

Clinical Features

  • Dysuria
  • Urethral discharge

Differential Diagnosis

Dysuria

Evaluation

Workup

  • Urinalysis
  • Urine GC/chlamydia
  • Consider M. genitalium and trichomonas testing

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
      • 500 mg, if weight <150 kg
      • 1 g, if weight ≥150 kg
  • Chlamydia


Ceftriaxone contraindicated

^Additional chlamydia coverage only needed if treated with cefixime only

Partner Treatment

Recurrent or Persistent

Target M. genitalium

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

Disposition

  • Outpatient

See Also

References