1. Urethritis in males

2. 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

3. 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

4. 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 : (+)

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

7. Complications of gu & NGU
Tysonitis
Lithritis
Cowperitis
Diferentitis
Epidemoorchitis

8. diagnosis GU NGU Gram stain smear - PMN/HPF > 5GU
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

9. 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

10. Laboratory Examination urethritis: T. vaginalis
Wet Mount (Saline )
Culture In Pouch
PMN
trichomonas
Sensitivity %
Specificity >99%
Sensitivity %
Specificity >99%

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

12. 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

13. 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

14. 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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