Overview:

● Urethritis is a lower urinary tract infection causing inflammation of the urethra, a
fibromuscular tube through which urine exits the body in both males and females, and
through which semen exits the body in males.
● Urethritis is strongly associated with sexually transmitted infections, and is characterized
as gonococcal or nongonococcal. The most common symptom of urethritis is urethral
discharge. This activity reviews the evaluation and management of urethritis and
highlights the role of interprofessional team members in collaborating to provide
well-coordinated care and enhance outcomes for affected patients.
● Neisseria gonorrhea is the leading cause of urethritis. Neisseria gonorrhea is a
gram-negative diplococci bacteria transmitted through sexual intercourse. The incubation
period is 2-5 days. Patients are commonly co-infected with Chlamydia trachomatis.
● Chlamydia trachomatis is the most common nongonococcal cause of urethritis and is
also transmittable through sexual intercourse. Chlamydia trachomatis is a small
gram-negative obligate intracellular parasitic bacteria. The incubation period is usually
7-14 days. It is commonly co-infected with Mycoplasma genitalium and Neisseria
gonorrhea.

Common Symptoms:
MALE:
● Pain or burning during urination. Painful, swollen testicles.
● Itching, redness, or swelling of the head of the penis or urethral opening.
● Discharge from the penis, which is usually yellowish or beige.

FEMALE:
● Frequent or urgent need to urinate. Fever and chills.
● Difficulty starting urination. Abdominal and pelvic pain.
● Itching, pain or discomfort when not urinating.
● Pain during sex. Vaginal or urethral discharge.

Treatments if recommended:
Start antibiotics:
● Treatment / Management
● Therapy should be directed based on the offending agent causing the urethritis.
● Gonococcal urethritis: the recommended treatment of choice is a single dose of
ceftriaxone 250mg intramuscular injection and a single dose of oral 1 gram of
azithromycin to cover for coinfection with chlamydia. Neisseria meningitides urethritis is
treated the same.
● Nongonococcal urethritis: the recommended treatment:
● Chlamydia trachomatis: The treatment of choice is a single dose of 1 gram of oral
azithromycin or 100mg doxycycline twice a day for seven days.
● Alternative treatment options are ofloxacin 300mg orally twice daily for seven days or
levofloxacin 500mg orally once a day for seven days. If coinfected with gonorrhea
treatment with one dose of 250mg ceftriaxone intramuscular injection in addition to 1
gram oral single dose azithromycin. In pregnant females, 1 gram orally of azithromycin
is the recommended treatment.

 

If pregnant females are unable to tolerate recommended
treatment, these patients should have treatment with one of the following regimens:
● Amoxicillin 500mg orally three times daily for seven days
● Erythromycin base 500 mg orally four times daily for seven days
● Erythromycin base 250 mg orally four times a day for 14 days
● Erythromycin ethyl succinate 800 mg orally four times daily for seven days
● Erythromycin ethyl succinate 400 mg orally four times a day for 14 days

​

● In females who are pregnant or lactating the following medication treatment options are
contraindicated: levofloxacin, ofloxacin, erythromycin estolate, and doxycycline. All
patients should undergo repeat testing three months after treatment and reinfection
should receive therapy with azithromycin.

● Mycoplasma genitalium: the recommended antibiotic of choice is azithromycin 1 gram
orally as a single dose, similar to treating Chlamydia. For those patients' infections
resistant to treatment with azithromycin, moxifloxacin is a treatment alternative.

● Trichomonas vaginalis urethritis, including pregnant patients, should be treated with
seven days of metronidazole 500 mg orally twice a day. Tolerance in pregnancy may be
reduced due to significant nausea or vomiting so the length of treatment may be allowed
to vary from five to seven days.

● The treatment regimens for the more common causes of urethritis are stated above. For
the less common causes, the therapy still depends on the etiology. An example of
urethritis caused by irritants from clothing, the therapy would include changes in soap
and the reduction of friction with less tight fit clothing. Another example is that
adenovirus is treated with supportive care involving hydration, NSAIDs, and bed rest due
to no current medical therapy approved and is a self-limiting illness..
● NO ROCEPHIN FOR VIRTUAL VISITS

Recommend Ancillary therapies
● Acetaminophen or ibuprofen for fever/chills or body aches.
● No sexual activities.
● Sexual partner (s) to be treated as well.
● Practice safe and protective sex.
Any treatment failures, SEE A HEALTHCARE PROVIDER FACE -TO- FACE.

​

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