Male Urethritis in Emergency Medicine Follow-up

  • Author: Michael C Plewa, MD; Chief Editor: Erik D Schraga, MD   more...
 
Updated: Apr 15, 2010
 

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).
Next

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.
Previous
Next

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.
  • Urethritis may recur.
  • Venereophobia, inflammation of the urethra resulting from persistent milking of the urethra for fear of recurrence, may develop.
  • Organisms involved in urethritis may also result in epididymitis, balanoposthitis, cystitis, and rarely sepsis, osteomyelitis, abscess formation, and septic arthritis.
  • 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 cervical neoplasia, postoperative infections (cuff cellulitis or abscess), Bartholin gland abscess, endometritis, cervicitis, pelvic inflammatory disease, tubo-ovarian abscess, scarring of the fallopian tube, and infertility. Pregnant women may experience preterm labor resulting in low birth weight newborns who may also be at risk for chorioamnionitis, meningitis, pneumonia, and conjunctivitis.
Previous
Next

Patient Education

Previous
 
Contributor Information and Disclosures
Author

Michael C Plewa, MD  Research Coordinator, Consulting Staff, Department of Emergency Medicine, Lucas County Emergency Physicians, Inc, and Mercy Saint Vincent 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.

Specialty Editor Board

David S Howes, MD  Professor of Medicine and Pediatrics, Section Chief and Emergency Medicine Residency Program Director, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine

David S Howes, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physicians-American Society of Internal Medicine, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: eMedicine Salary Employment

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.

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  Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

References

  1. Gaydos CA, Maldeis N, Hardick A, Hardick J, Quinn TC. Mycoplasma genitalium Compared to Chlamydia, Gonorrhea, and Trichomonas as an Etiologic Agent of Urethritis in Men Attending STD Clinics. Sex Transm Infect. Apr 20 2009;[Medline].

  2. Iser P, Read TH, Tabrizi S, Bradshaw C, Lee D, Horvarth L, et al. Symptoms of non-gonococcal urethritis in heterosexual men: a case control study. Sex Transm Infect. Apr 2005;81(2):163-5. [Medline].

  3. Moi H, Reinton N, Moghaddam A. Mycoplasma genitalium is associated with symptomatic and asymptomatic non-gonococcal urethritis in men. Sex Transm Infect. Feb 2009;85(1):15-8. [Medline].

  4. Wetmore CM, Manhart LE, Golden MR. Idiopathic urethritis in young men in the United States: prevalence and comparison to infections with known sexually transmitted pathogens. J Adolesc Health. Nov 2009;45(5):463-72. [Medline].

  5. Herz D, Weiser A, Collette T, Reda E, Levitt S, Franco I. Dysfunctional elimination syndrome as an etiology of idiopathic urethritis in childhood. J Urol. Jun 2005;173(6):2132-7. [Medline].

  6. Eradi B, Ninan GK. Intravesical steroid instillation--a novel therapeutic intervention for idiopathic urethritis of childhood. Eur J Pediatr Surg. Apr 2009;19(2):105-7. [Medline].

  7. Furuya R, Takahashi S, Furuya S, Saitoh N, Ogura H, Kurimura Y, et al. Is urethritis accompanied by seminal vesiculitis?. Int J Urol. Jul 2009;16(7):628-31. [Medline].

  8. Shahmanesh M, Moi H, Lassau F, Janier M. 2009 European guideline on the management of male non-gonococcal urethritis. Int J STD AIDS. Jul 2009;20(7):458-64. [Medline].

  9. 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].

  10. [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].

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

  12. Hobbs MM, Lapple DM, Lawing LF, Schwebke JR, Cohen MS, Swygard H, et al. Methods for detection of Trichomonas vaginalis in the male partners of infected women: implications for control of trichomoniasis. J Clin Microbiol. Nov 2006;44(11):3994-9. [Medline].

  13. 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].

  14. 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.

  15. 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].

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

  17. 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].

  18. Jensen JS, Bradshaw CS, Tabrizi SN, Fairley CK, Hamasuna R. Azithromycin treatment failure in Mycoplasma genitalium-positive patients with nongonococcal urethritis is associated with induced macrolide resistance. Clin Infect Dis. Dec 15 2008;47(12):1546-53. [Medline].

  19. 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].

  20. 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].

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

  22. Bradshaw CS, Jensen JS, Tabrizi SN, Read TR, Garland SM, Hopkins CA, et al. Azithromycin failure in Mycoplasma genitalium urethritis. Emerg Infect Dis. Jul 2006;12(7):1149-52. [Medline].

  23. Jernberg E, Moghaddam A, Moi H. Azithromycin and moxifloxacin for microbiological cure of Mycoplasma genitalium infection: an open study. Int J STD AIDS. Oct 2008;19(10):676-9. [Medline].

  24. Wikstrom 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].

  25. 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].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.