STD

Non-Gonococcal Urethritis

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Non-Gonococcal Urethritis, Nongonococcal Urethritis

  • 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
  • Symptoms
  1. Urethral discharge
  2. Dysuria
  • Differential Diagnosis
  • 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)
  • Management
  1. Precaution
    1. See Dysuria for a more complete protocol for evaluation and management
    2. Also give Ceftriaxone 250 mg IM empirically to cover for Gonorrhea
  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 Moxifloxacin 400 mg orally daily for 10 days for resistant Mycoplasma
  • Resources
  1. Non-Gonococcal Urethritis (Stat Pearls)
    1. https://www.ncbi.nlm.nih.gov/books/NBK535411/