Urethritis - male
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Urethral discharge and/or dysuria are typical symptoms of male urethritis.
- Chlamydia trachomatis and Neisseria gonorrhoeae are the most common causes of male urethritis.
- Other organisms include:Mycoplasma genitalium, Herpes simplex virus (HSV), adenoviruses and Trichomonas vaginalis, Ureaplasma urealyticum exist as normal urethral flora.
- Mycoplasma genitalium is developing resistance to single dose treatments used for Chlamydia trachomatis complicating the choice of first line treatment of urethritis for some men.
- Chlamydia trachomatis infection at non-genital sites may not be treated adequately with single dose treatments.
If copious and purulent, it is more indicative of gonorrhoea than other causes. However, any cause can produce scant and mucoid discharge.
In young men, indicates an STI until proven otherwise.
Suggestive of bladder infection.
|Gonorrhoea*||FPU||NAAT. If NAAT test result is positive, take swab at relevant site(s) for culture, before treatment.|
FPU – First pass urine
NAAT – Nucleic acid amplification test
NGU – Non-gonococcal urethritis
* If test results are negative and symptoms persist, consider referral for testing of FPU for M. genitalium, herpes simplex virus (HSV) and adenovirus and microscopy for non-gonococcal urethritis (if not available through general practice).
Specimen collectionClinician collected | Self-collection
Special considerationsFor men who have sex with men (MSM), undertake the following additional tests:
|Principle treatment options|
|Chlamydia and NGU||
Azithromycin 1g PO, stat OR
Doxycycline 100mg PO, BD for 7 days
Seek specialist advice
Ceftriaxone 500mg in 2mL of 1% lignocaine IMI, stat
Seek specialist advice
|NGU – Non-gonococcal urethritis|
- Chlamydia is the most common cause of male urethritis in Australia, therefore it is recommended to treat for this initially while waiting for other test results.
- Consider seeking specialist advice before treating infection other than chlamydia/gonorrhoea.
- If symptoms do not resolve, seek specialist advice for management of persistent NGU, including M. genitalium, herpes simplex virus (HSV) and adenovirus.
Other immediate management
- Advise no sexual contact for 7 days after treatment is administered
- Advise no sex with partners from the last 6 months until the partners have been tested and treated if necessary.
- Contact tracing
- Provide patient with factsheet.
If STI confirmed, follow up provides an opportunity to:
- Confirm patient adherence to treatment and assess for symptom resolution
- Confirm contact tracing procedures have been undertaken or offer more contact tracing support
- Provide further sexual health education and prevention counselling.
For test of cure (TOC) and retesting advice see:
- 100% of patients diagnosed with NGU are treated with an appropriate antibiotic regimen
- 100% of patients are advised to avoid sexual contact for 7 days after treatment is prescribed.
Drugs, HIV and Viral Hepatitis Group, British Association for Sexual Health and HIV (BASHH) 2013. Available from: http://www.bashh.org/BASHH/Guidelines/Guidelines/BASHH/Guidelines/Guidelines.aspx