Emergency Department 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 (GU).

Refer patients to their primary physician, urologist, or local health department for follow-up care.

Instruct patients regarding abstinence from sex 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. Consider expedited partner therapy (EPT), in states where this is allowed, for partners who do not have timely access to treatment. This includes all sexual partners of the patient with GU during the last 60 days or the most recent sexual partner if last intercourse was more than 60 days before 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.

Urethritis may recur. Recurrence may be less likely because of noncompliance with treatment than was previously thought^[45] and should prompt consideration for atypical infections, including M genitalium and trichomonal infections.

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.

Pharyngeal infection with Neisseria gonorrhoeae or Chlamydia trachomatis can occur. The prevalence of these organisms in the pharynx of men with urethritis may be as high as 20% and 6%, respectively.^[46]

Gonorrhea can become disseminated and also result in 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 GU 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.

Guidelines

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