Urethritis in males

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

Urethritis etiologies STI NON STI Gonococcal urethritis (GU) Neisseria gonorrhoeae Non Gonococcal Urethritis (NGU) Chlamydia trachomatis : 15-40% Mycoplasma genitalium : 15-25% Trichomonas vaginalis : 5-15% Ureaplasma urealiticum : 5-15% Herpes simplex virus type 1&2 : 2-3% Adenovirus : 2-4% Urinary tract infection Bacterial prostatitis Urethral stricture Phymosis Instrumentation of urethra Chemical iritation Tumor Congenital anomaly

signs & symptoms Gonococcal Urethritis Non-Gonococcal Urethritis   Gonococcal Urethritis Non-Gonococcal Urethritis Incubation period 2-6 days 1-5 weeks Discharge - Quantity profuse scant or absent (spontaneous flow) - Color Purulent Mucoid (yellowish or greenish) (white/clear) Dysuria (+) mild or absent itching or tingling Herpes simplex virus : (+)

Gonococcal Urethritis Non-Gonococcal Urethritis   Gonococcal Urethritis Non-Gonococcal Urethritis Meatitis (+) Occasionally Herpes simplex virus (+) Penile edema Rarely rarely, Inguinal Lymphadenopathy (+)/(-)

Complications of gu & NGU Tysonitis Lithritis Cowperitis Diferentitis Epidemoorchitis

diagnosis GU NGU Gram stain smear - PMN/HPF > 5   GU NGU Gram stain smear - PMN/HPF > 5 - Intracellular Gram negative diplococci (+) (-) Culture Modified Thayer Martin T. vaginalis Polymerase chain reaction Herpes simplex virus (HSV) M. genitalium C. trachomatis Serologic HSV: IgM, IgG

Laboratory Examination: N. gonorrhoeae Gram smear PMN ≥ 5/hpf Intracellular gram (-) diplococcus (ICDC) Culture ICDC PCR PMN Sensitivity 97.3% Specificity 98.9% Sens (%) Spec (%) Symptom (+) 90-95 90-99 Symptom (-) 50-70 85-87 Sens (%) Spec (%) Symptom (+) 94-98 >99 Symptom (-) 80-85

Laboratory Examination urethritis: T. vaginalis Wet Mount (Saline ) Culture In Pouch PMN trichomonas Sensitivity 50-75% Specificity >99% Sensitivity 80-90% Specificity >99%

treatment Comprehensive case management: Identification of syndromes Antimicrobial treatment Education Condom supply Counselling Examination & treatment of sexual partners Screening - Syphilis :VDRL & TPHA - HIV : antiHIV

Treatment UNCOMPLICATED GU GONOCOCCAL URETHRITIS RECOMMENDED Cefixime 400mg, orally, single dose Or Levofloxacin* 500mg, orally, single dose ALTERNATIVES Kanamycin 2gr, intramuscular, single dose or Thiamphenicol ** 3.5gr, orally, single dose Ceftriaxone 250mg, intramuscular, single dose NON GONOCOCCAL URETHRTITIS RECOMMENDED Azithromycin 1gr, orally, single dose or Doxycycline** 2x100mg, orally, 7 days ALTERNATIVES Erythromycin 4x500mg, orally, 7 days + *not for children under 12 years of age **not for pregnant women

Treatment for COMPLICATED GU GONOCOCCAL URETHRITIS RECOMMENDED Cefixime1 x400mg, orally, 5 days or Levofloxacin* 1x500mg, orally, 5 days ALTERNATIVES Kanamycin 1x2gr, intramuscular, 3 days Thiamphenicol **1x3.5gr, orally, 5 days Or Ceftriaxone 1x250mg, intramuscular, 3 days + NGU treatment *not for children under 12 years of age **not for pregnant women

Treatment for trichomoniasis Recommended: Metronidazole* 2gr, orally, single dose Other choice of treatment: Metronidazole 2x500mg/daily, orally, 7 days * Consuming alcohol should be avoided during treatment & for 24 hours thereafter

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