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Non-gonococcal urethritis

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of non-gonococcal urethritis are prepared by our editorial team based on guidelines from the Center for Disease Control (CDC 2021), the Japanese Association for Infectious Disease (JAID/JSC 2021), the British Association for Sexual Health and HIV (BASHH 2018), and the International Union Against Sexually Transmitted Infections (IUSTI 2016)....
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Screening and diagnosis

Diagnosis
As per IUSTI 2016 guidelines:
Confirm urethritis by demonstrating polymorphonuclear leukocytes from the anterior urethra using a Gram or methylene-blue stained urethral smear, which should contain 5 polymorphonuclear leukocytes/hpf (averaged over 5 fields with the greatest concentration of polymorphonuclear leukocytes).
Consider diagnosing urethritis based on the following criteria if microscopy is not available:
presence of a mucopurulent or purulent urethral discharge on examination
≥ 1+ on a leukocyte esterase dipstick in a first void urine specimen
threads in a first void urine specimen (threads may be physiological, such as semen)
C
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Classification and risk stratification

Classification: as per JAID/JSC 2021 guidelines, Classify urethritis into gonococcal and non-gonococcal depending on the causative microorganism.
A
Classify non-gonococcal urethritis further into chlamydial urethritis and non-chlamydial non-gonococcal urethritis.
B

Diagnostic investigations

Indication for testing: as per IUSTI 2016 guidelines, Evaluate for urethritis in patients with symptoms or visible discharge.
B
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More topics in this section

  • First void urine

  • Urethral smear

  • Vaginal smear

  • Antimicrobial susceptibility testing

  • Assessment of sexual partners

Medical management

Empirical therapy: as per IUSTI 2016 guidelines, Do not initiate empirical treatment without verifying the presence of urethritis, as there is a risk of perpetuating the symptoms.
D

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  • First-line therapy

  • Second-line therapy

Patient education

Avoidance of sexual intercourse: as per JAID/JSC 2021 guidelines, Evaluate and treat sexual partners of male patients with urethritis.
A

Follow-up and surveillance

Follow-up testing: as per BASHH 2018 guidelines, Obtain a test of cure in all patients 5 weeks after the start of treatment (and no sooner than 3 weeks to avoid false negative results) to ensure microbiological cure and to help identify emerging resistance.
B

More topics in this section

  • Evaluation of persistent/recurrent disease

  • Management of persistent/recurrent disease