Urethritis [Men]

Valeria Fabre, M.D.
Urethritis [Men] is a topic covered in the Johns Hopkins ABX Guide.

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PATHOGENS

  • Gonococcal urethritis:5-20%
  • Non-gonococcal urethritis:
    • Chlamydia trachomatis (CT): the most frequent cause of urethritis in men accounting for 23%-55% of cases. However, the proportion of non-gonococcal urethritis (NGU) cases due to CT is declining gradually.
    • Mycoplasma genitalium: maybe the second most frequent cause of urethritis in the U.S. and UK. It May account for between 15%-22% of cases of acute NGU. It also has a role in chronic NGU.
    • Trichomonas vaginalis: is the cause of only about 2% of cases of acute NGU but probably a higher proportion of chronic NGU.
      • Risks in men for infertility, HIV.
    • Ureaplasma urealyticum: biovar 2 is probably a more important cause of acute NGU than previously realized. Note that organisms can be cultured in 30-40% of asymptomatic men. Quantification of the organism may help establish a diagnosis.
  • Less common: include
    • Herpes simplex virus (rare in the absence of noticeable skin lesions)
    • Adenovirus
    • Haemophilus spp
    • Yeasts, e.g., Candida spp.
    • N. meningitidis
      • Increasingly described in symptomatic MSM.
    • Staphylococcus saprophyticus.
    • Novel bacteria recently associated with bacterial vaginosis, such as Leptotrichia/Sneathia spp. may be the urethral pathogens of "idiopathic" NGU[9].

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PATHOGENS

  • Gonococcal urethritis:5-20%
  • Non-gonococcal urethritis:
    • Chlamydia trachomatis (CT): the most frequent cause of urethritis in men accounting for 23%-55% of cases. However, the proportion of non-gonococcal urethritis (NGU) cases due to CT is declining gradually.
    • Mycoplasma genitalium: maybe the second most frequent cause of urethritis in the U.S. and UK. It May account for between 15%-22% of cases of acute NGU. It also has a role in chronic NGU.
    • Trichomonas vaginalis: is the cause of only about 2% of cases of acute NGU but probably a higher proportion of chronic NGU.
      • Risks in men for infertility, HIV.
    • Ureaplasma urealyticum: biovar 2 is probably a more important cause of acute NGU than previously realized. Note that organisms can be cultured in 30-40% of asymptomatic men. Quantification of the organism may help establish a diagnosis.
  • Less common: include
    • Herpes simplex virus (rare in the absence of noticeable skin lesions)
    • Adenovirus
    • Haemophilus spp
    • Yeasts, e.g., Candida spp.
    • N. meningitidis
      • Increasingly described in symptomatic MSM.
    • Staphylococcus saprophyticus.
    • Novel bacteria recently associated with bacterial vaginosis, such as Leptotrichia/Sneathia spp. may be the urethral pathogens of "idiopathic" NGU[9].

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Last updated: January 14, 2023