Urethritis

Question 1

What is urethritis?

Answer 1

• Inflammation of urethra
• Gonococcal urethritis or non-gonococcal

Question 2

Causative organisms for each urethritis type

Answer 2

• Gonococcal - neisseria gonorrhoeae
• Non-gonococcal - Chlamydia trachomatis, mycoplasma genitalium, trichomonas vaginalis

Question 3

RF for urethritis

Answer 3

• Age <25
• Men who have sex with men
• Previous STI
• Recent/new sexual partner
• One or more partner in last year

Question 4

Symptoms of urethritis

Answer 4

• Dysuria
• Penile irritation
• Discharge from urethral meatus
• Complications - eg reactive arthiritis, epididymitis

Question 5

Sexual history importance urethritis

Answer 5

• Narrow down likely pathogens
• Risk stratify burden of disease
• Inform necessary additonal sexual health screens
• Partner notification

Question 6

What is reactive arthiritis? Common causative organisms

Answer 6

• Sterile inflammatory arthritis
• Caused by distant infection producing autoimmune response in certain joints
• Commonly caused by chlamydia trachomatis, chlamydia pneumoniae, camplylobacter, shigella or salmonella

Question 7

Presentation of reactive arthiritis

Answer 7

• Lower limb joints
• Oligoarthiritis

Other extra-articular:
* Conjunctivitis/uveitis
* Urethritis/cervicitis/prostatitis
* Keratoderma blenorrhagicum
* Painless oral ulcers
* Malaise/fatigue

Question 8

Management reactive arthiritis

Answer 8

• Usually resolves within 6 months
• Rest
• Treat affected joint with NSAIDs or local steroid injections

Question 9

Bedside tests for urethritis

Answer 9

• Urethral swab - gram stain
• First void urine NAAT - gonorrhoea, chlamydia, m.genitalium
• Urine dip - send MSU for MC&S if suggests infection
• Consider further STI testing eg HIV and syphilus serology

Question 10

What is triple site testing?

Answer 10

• Swab genitals, pharynx and rectum
• Do this if suspect gonococcal infection

Question 11

Management urethritis

Answer 11

Abx - BASHH guidelines

Question 12

Abx for gonococcal vs non-gonococcal urethritis

Answer 12

• Gonococcal - Ceftriaxone IM + Azithromycin PO
• Non-gonococcal - Doxycycline oral OR Azithromycin PO

Question 13

Long term management urethritis

Answer 13

• Abstain from sexual activity until abx course finished, symptoms have resolved and sexual partners treated
• If gonorrhoea - test of cure is needed
• Counsel on condom use
• Advise to notify sexual partners and to attend sexual health clinic for testing and treatment

Question 14

Contact tracing guidelines urethritis

Answer 14