eMedicine Specialties > Emergency Medicine > Genitourinary

Urethritis, Male: Follow-up

Author: Michael C Plewa, MD, Research Coordinator, Consulting Staff, Department of Emergency Medicine, Lucas County Emergency Physicians, Inc, and Saint Vincent Mercy Medical Center
Contributor Information and Disclosures

Updated: Aug 4, 2009

Follow-up

Further Outpatient Care

  • Refer patients to their primary physician, urologist, or local health department for follow-up care.
  • Recurrent or persistent symptoms should prompt culture for N gonorrhoeae to determine resistance, as well as evaluation or treatment for T vaginalis and Mycoplasma and Ureaplasma species.
  • Retesting in 3 months is recommended for men with gonococcal urethritis (GCU).

Deterrence/Prevention

  • Instruct patients regarding abstinence for 1 week (or until therapy is complete and symptoms have resolved) and safe sex practices (condom use) thereafter.
  • Sexual partners should be referred for evaluation and treatment. This includes all sexual partners of the patient with GCU during the last 60 days or the most recent sexual partner if last intercourse was more than 60 days prior to symptoms.

Complications

  • Urethritis can rarely result in urethral stricture, urethral stenosis, or periurethral abscess formation.
  • Chronic prostatitis, diagnosed when symptoms of urinary discomfort persist beyond 3 months, and epididymitis can follow untreated urethritis.
  • Recurrent urethritis
  • Reactive arthritis following chlamydial infection is uncommon.
  • Infertility in men following untreated urethritis is rare.
  • The greatest risk, especially in asymptomatic men with NGU, is sexual transmission during unprotected sex.
  • Sexual transmission of GCU or NGU to women may lead to cervicitis, pelvic inflammatory disease, tubo-ovarian abscess, scarring of the fallopian tube, and infertility.

Patient Education

Miscellaneous

Special Concerns

  • Recurrent symptoms may be related to reexposure, noncompliance, chronic nonbacterial prostatitis, or infection with T vaginalis, M genitalium, or U urealyticum. Recommended therapy includes either a single dose of metronidazole 2 g orally or tinidazole 2 g orally, for the Trichomonas, and azithromycin one dose of 1 g or moxifloxacin 400 mg daily for 10 days for either Mycoplasma or Ureaplasma. Prolonged (14-28 d) therapy with erythromycin has not been demonstrated to be of value.
  • Treatment regimens are the same whether the patient is HIV positive or HIV negative.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Walter Elrod, MD, to the development and writing of this article.



More on Urethritis, Male

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Follow-up: Urethritis, Male
References
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References

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  2. Kirsch TD, Shesser R, Barron M. Disease surveillance in the ED: factors leading to the underreporting of gonorrhea. Am J Emerg Med. Mar 1998;16(2):137-40. [Medline].

  3. [Guideline] CDC. 2006 guidelines for treatment of sexually transmitted diseases. Centers for Disease Control and Prevention. MMWR Morb Mortal Wkly Rep. 55(RR-11):1-94. [Full Text].

  4. [Guideline] CDC, Workowski KA, Berman SM. Sexually transmitted diseases treatment guidelines, 2006. MMWR Recomm Rep. Aug 4 2006;55(RR-11):1-94. [Medline].

  5. Chen PL, Hsieh YH, Lee HC, et al. Suboptimal therapy and clinical management of gonorrhoea in an area with high-level antimicrobial resistance. Int J STD AIDS. Apr 2009;20(4):225-8. [Medline].

  6. CDC. Update to CDC's Sexually transmitted diseases treatment guidelines, 2006: fluoroquinolones no longer recommended for treatment of gonococcal infections. MMWR [serial online]. Apr 13 2007;56(14):332-334. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5614a3.htm?s_cid=mm5614a3_e.

  7. Mena LA, Mroczkowski TF, Nsuami M, Martin DH. A randomized comparison of azithromycin and doxycycline for the treatment of Mycoplasma genitalium-positive urethritis in men. Clin Infect Dis. Jun 15 2009;48(12):1649-54. [Medline].

  8. Falk L, Fredlund H, Jensen JS. Tetracycline treatment does not eradicate Mycoplasma genitalium. Sex Transm Infect. Aug 2003;79(4):318-9. [Medline].

  9. Lau CY, Qureshi AK. Azithromycin versus doxycycline for genital chlamydial infections: a meta-analysis of randomized clinical trials. Sex Transm Dis. Sep 2002;29(9):497-502. [Medline].

  10. Maeda S, Yasuda M, Ito S, Seike K, Ito S, Deguchi T. Azithromycin treatment for nongonococcal urethritis negative for Chlamydia trachomatis, Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma parvum, and Ureaplasma urealyticum. Int J Urol. Feb 2009;16(2):215-6. [Medline].

  11. Takahashi S, Matsukawa M, Kurimura Y, et al. Clinical efficacy of azithromycin for male nongonococcal urethritis. J Infect Chemother. Dec 2008;14(6):409-12. [Medline].

  12. Bradshaw CS, Chen MY, Fairley CK. Persistence of Mycoplasma genitalium following azithromycin therapy. PLoS One. 2008;3(11):e3618. [Medline].

  13. Lyss SB, Kamb ML, Peterman TA, et al. Chlamydia trachomatis among patients infected with and treated for Neisseria gonorrhoeae in sexually transmitted disease clinics in the United States. Ann Intern Med. Aug 5 2003;139(3):178-85. [Medline].

  14. Wikström A, Jensen JS. Mycoplasma genitalium: a common cause of persistent urethritis among men treated with doxycycline. Sex Transm Infect. Aug 2006;82(4):276-9. [Medline].

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Further Reading

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Keywords

urethritis, inflammation of the urethra, urethritis symptoms, urethritis treatment, urethral discharge, dysuria, sexually transmitted disease, STD, infectious urethritis, posttraumatic urethritis, gonococcal urethritis, GC urethritis, GCU, nongonococcal urethritis, NG urethritis, NGU, Neisseria gonorrhoeae, N gonorrhoeae, Chlamydia trachomatis, C trachomatis, Ureaplasma urealyticum, U urealyticum, Mycoplasma hominis, M hominis, Mycoplasma genitalium, Trichomonas vaginalis, T vaginalis, lymphogranuloma venereum, herpes genitalis, syphilis, mycobacterium, epididymitis, orchitis, prostatitis, proctitis, Reiter syndrome, urinary tract infection, pyelonephritis, arthritis, conjunctivitis, iritis, urethral stricture, reactive arthritis, Mycoplasma Infections

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Contributor Information and Disclosures

Author

Michael C Plewa, MD, Research Coordinator, Consulting Staff, Department of Emergency Medicine, Lucas County Emergency Physicians, Inc, and Saint Vincent Mercy Medical Center
Michael C Plewa, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Physicians for Social Responsibility, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

David S Howes, MD, Residency Program Director, Professor of Medicine, Section of Emergency Medicine, University of Chicago/Pritzker School of Medicine
David S Howes, MD is a member of the following medical societies: American College of Emergency Physicians, American College of Physicians-American Society of Internal Medicine, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Richard H Sinert, DO, Associate Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center
Richard H Sinert, DO is a member of the following medical societies: American College of Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Erik D Schraga, MD, Consulting Staff, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates; Consulting Staff, Permanente Medical Group, Kaiser Permanente, Santa Clara Medical Center
Disclosure: Nothing to disclose.

 
 
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