Non-Gonococcal Urethritis

Aka: Non-Gonococcal Urethritis, Nongonococcal Urethritis

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II. Causes

  1. See Dysuria (Urethritis)
  2. Chlamydia trachomatis (35-45%)
  3. Mycoplasma Genitalium (30%)
  4. Trichomonas vaginalis (13%)
  5. Ureaplasma Urealyticum or Ureaplasma Parvum
    1. Unclear if Ureaplasma causes Urethritis
  6. Herpes Simplex Virus

III. Symptoms

  1. Urethral discharge
  2. Dysuria

IV. Differential Diagnosis

  1. See Dysuria
  2. Trichomonas
    1. Consider if no response to Azithromycin, Doxycycline
  3. Chlamydia trachomatis

V. Labs

  1. See Sexually Transmitted Infection
  2. Gonorrhea PCR
  3. Chlamydia PCR
  4. Trichomonas PCR or Wet Prep
  5. Mycoplasma Genitalium NAAT may be available (esp for persistent or recurrent symptoms)

VI. Management

  1. Precaution
    1. See Dysuria for a more complete protocol for evaluation and management
    2. Also give Ceftriaxone 500 mg IM/IV for 1 dose (1 gram IM/IV if weight > 150 kg) if Gonorrhea not excluded
  2. First-Line (empiric for Chlamydia AND Trichomonas)
    1. Azithromycin 1 gram for one dose AND
    2. Metronidazole 2 grams for one dose
  3. Alternative regimen
    1. Doxycycline 100 mg orally twice daily for 7 days AND
    2. Tinidazole 2 grams for one dose
  4. Persistent Urethritis
    1. See Dysuria
    2. Consider resistant Mycoplasma Genitalium
      1. See Mycoplasma Genitalium for treatment regimen
      2. Consider Moxifloxacin 400 mg orally daily for 10 days (after initial Doxycycline course)

VII. Resources

  1. Non-Gonococcal Urethritis (Stat Pearls)
    1. https://www.ncbi.nlm.nih.gov/books/NBK535411/

VIII. References

  1. (2018) Sanford Guide, accessed on IOS 11/7/2019
  2. Stamm (1995) JAMA 274:545-9 [PubMed]
  3. Workowski (2015) MMWR Morb Mortal Wkly Rep 64:1-137 [PubMed]

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