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Non-Gonococcal Urethritis
Aka: Non-Gonococcal Urethritis, Nongonococcal Urethritis
- See Also
- Sexually Transmitted Infection
- Chlamydia
- Gonorrhea
- Dysuria
- Dysuria in Women
- Dysuria in Men
- Dysuria in Children
- Causes
- See Dysuria (Urethritis)
- Chlamydia trachomatis (35-45%)
- Mycoplasma Genitalium (30%)
- Trichomonas vaginalis (13%)
- Ureaplasma urealyticum or Ureaplasma parvum
- Unclear if Ureaplasma causes Urethritis
- Herpes Simplex Virus
- Symptoms
- Urethral discharge
- Dysuria
- Differential Diagnosis
- See Dysuria
- Trichomonas
- Consider if no response to Azithromycin, Doxycycline
- Chlamydia trachomatis
- Labs
- See Sexually Transmitted Infection
- Gonorrhea PCR
- Chlamydia PCR
- Trichomonas PCR or wet prep
- Mycoplasma GenitaliumNAAT may be available (esp for persistent or recurrent symptoms)
- Management
- Precaution
- See Dysuria for a more complete protocol for evaluation and management
- Also give Ceftriaxone 500 mg IM/IV for 1 dose (1 gram IM/IV if weight > 150 kg) if Gonorrhea not excluded
- First-Line (empiric for Chlamydia AND Trichomonas)
- Azithromycin 1 gram for one dose AND
- Metronidazole 2 grams for one dose
- Alternative regimen
- Doxycycline 100 mg orally twice daily for 7 days AND
- Tinidazole 2 grams for one dose
- Persistent Urethritis
- See Dysuria
- Consider resistant Mycoplasma Genitalium
- See Mycoplasma Genitalium for treatment regimen
- Consider Moxifloxacin 400 mg orally daily for 10 days
- Resources
- Non-Gonococcal Urethritis (Stat Pearls)
- https://www.ncbi.nlm.nih.gov/books/NBK535411/
- References
- (2018) Sanford Guide, accessed on IOS 11/7/2019
- Stamm (1995) JAMA 274:545-9 [PubMed]
- Workowski (2015) MMWR Morb Mortal Wkly Rep 64:1-137 [PubMed]