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URETHRITIS IN
MALES
Definition
Inflammation of urethral in response to
inflammation of any etiology
Characterized by urethral discharge,
dysuria, or itchy
Causes by sexually transmitted
Infection (STI) and nonSTI

URETHRITIS
ETIOLOGIES
STI
Gonococcal urethritis (GU)
Neisseria gonorrhoeae

Non Gonococcal Urethritis (NGU)

Chlamydia trachomatis
Mycoplasma genitalium
Trichomonas vaginalis
Ureaplasma urealiticum
Herpes simplex virus type
Adenovirus

: 15-40%
:15-25%
: 5-15%
: 5-15%
1&2 : 2-3%
: 2-4%

NON
Urinary tract
STI
infection
Bacterial
prostatitis
Urethral stricture
Phymosis
Instrumentation of
urethra
Chemical iritation
Tumor
Congenital
anomaly

SIGNS &
SYMPTOMS

Incubation
period
Discharge
Quantity

- Color

Gonococcal
Urethritis

Non-Gonococcal
Urethritis

2-6 days

1-5 weeks

profuse
(spontaneous
flow)
Purulent
(yellowish or
greenish)

scant or absent

Mucoid

(white/clear)
- mild or absent
itching or tingling,

Gonococcal
Urethritis
(+)

Non-Gonococcal
Urethritis
Occasionally
(+) in Herpes
simplex virus (HSV)

Penile edema

Rarely

Rarely
(+) in Herpes
simplex virus (HSV)

Inguinal
Lymphadenopat
hy

(+)/(-)

Meatitis

(+)

COMPLICATIONS
OF GU & NGU
Tysonitis

Lithritis

Diferentitis

Cowperitis

Epidemoorchit
is

TYSONITIS

Epididimoorch
itis

EPIDIDIMOORKITIS

DIAGNOSIS

Gram stain smear

- PMN/HPF
- Intracellular Gram
negative
Diplococci (ICDC)
Culture
Polymerase chain
reaction

GU

>5

NGU

>5

(+)
Modified Thayer
Martin

(-)

(+)

T. vaginalis
HSV
M.
genitalium
T. vaginalis
C.
trachomatis

THERAPY
Non-

pharmacolo
gy

Comprehens
ive case
managemen
t:

Identification of
syndromes
Antimicrobial treatment
Education
Condom supply
Counselling
Examination &
treatment of sexual
partners
Syphilis & HIV screening

TREATMENT FOR
UNCOMPLICATED
GU

GONOCOCCAL URETHRITIS

NON GONOCOCCAL URETHRTITIS

RECOMMENDED
Cefixim 400mg, orally, single dose
or
Levofloxacin* 500mg, orally, single
dose
ALTERNATIVES
Kanamycin 2gr, intramuscular,
single dose
or
Thiamfenicol ** 3.5gr, orally, single
dose
or
Ceftriaxone 250mg, intramuscular,
single dose

Contraindication in children < 12 years & pregnancy

* Contraindication in pregnancy

RECOMMENDED
Azithromycin 1gr, orally, single
dose
or
Doxycycline* 2x100mg, orally, 7
days
ALTERNATIVES
Erythromycin 4x500mg, orally, 7
days

TREATMENT FOR
COMPLICATED GU
GONOCOCCAL URETHRITIS
RECOMMENDED
Cefixim 1x400mg, orally, 5 days
or
Levofloxacin* 1x500mg, orally, 5
days
ALTERNATIVES
Kanamycin 1x2gr, intramuscular, 5
days
or
Thiamfenicol ** 1x3.5gr, orally, 5
days
or
Ceftriaxone 1x250mg,
intramuscular, 5 days

Contraindication in children < 12 years & pregnancy

* Contraindication in pregnancy

+NGU treatment

TREATMENT FOR
TRICHOMONIASIS
TRICHOMONIASIS
Recommended: Metronidazole* 2gr, orally, single dose
Other choice of treatment: Metronidazole* 2x500mg/daily, orally,
7 days

* Avoiding alcohol intake

THANK YOU