Urethritis is a well-defined clinical syndrome manifested by dysuria, a urethral discharge, or both.
_ The major single specific etiology of acute urethritis is Neisseria gonorrhoeae, producing gonococcal urethritis (GCU). Urethritis of all other etiologies is called nongonococcal urethritis (NGU).
_ N. gonorrhoeae is a gram-negative, kidneyshaped diplococcus with flattened opposed margins. The urethra is the most common site of infection in all men.
_ Symptoms of GCU: urethral discharge and dysuria are the most common symptoms. There is complaint of urethral itching. Prostatic involvement can cause frequency, urgency, and nocturia. It can involve the epididymis through spreading down the vas deferens, causing acute epididymitis.
_ Incubation period: 3 to 10 days. Without treatment, urethritis persists for 3 to 7 wk, with 95% of men becoming asymptomatic after 3 mo. GCU is asymptomatic in up to 60% of contacts.
_ Signs of GCU: yellow-brown discharge, meatal edema, urethral tenderness to palpation.
Nucleic acid amplification tests (NAATs)
Calcium alginate or rayon swab on a metal shaft (not cotton-tipped swabs, which are bactericidal) of the urethra should be performed anywhere from 2 to 4 hr after voiding to prevent bacterial washout with voiding
Concomitant serologic testing for syphilis on all patients.
Concomitant Chlamydia testing on all patients.
Ceftriaxone 250 mg IM × 1 dose plus azithromycin 1 g orally single dose. Doxycycline 100 mg orally twice/day for 7 days can be substituted for azithromycin in cases of allergy to azithromycin.
_ Alternative regimens
Cefixime 400 mg PO × 1 dose plus azithromycin 1 g orally single dose.