Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • urethral discharge in men
  • tenderness and/or swelling of the epididymis
  • pelvic pain
  • mucopurulent or purulent exudate at the endocervix

Other diagnostic factors

  • urethral irritation in men
  • dysuria in men
  • tenderness and/or swelling of testis
  • tenderness and/or swelling of prostate
  • anal pruritus
  • mucopurulent discharge from the rectum
  • rectal pain
  • tenesmus
  • rectal bleeding
  • vaginal discharge
  • cervical friability
  • uterine, adnexal, or cervical motion tenderness
  • uterine mass
  • anterior cervical lymphadenopathy
  • conjunctivitis
  • fever
  • skin lesions (papules, bullae, or necrotic) at extremities
  • polyarthritis
  • purpuric rash
  • positive Brudzinski and Kernig sign
  • seizures
  • focal cerebral signs
  • murmur
  • ophthalmia neonatorum
  • rhinitis
  • urethritis (infantile)
  • vaginitis

Risk factors

  • age 15-24 years
  • black ancestry
  • men who have sex with men (MSM)
  • current or prior history of STD
  • multiple recent sexual partners
  • inconsistent condom use
  • substance use
  • past incarceration
  • risk factors of partner
  • history of sexual or physical abuse
  • high-morbidity community

Diagnostic investigations

1st investigations to order

  • culture
  • urinalysis in men
  • Gram stain of urine sediment
  • Gram strain of urethral discharge
  • nucleic acid amplification test (NAAT)
  • HIV test
  • VDRL
  • serum rapid plasma reagin (RPR) test
Full details

Investigations to consider

  • transvaginal ultrasound
  • pelvic CT/MRI
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Assistant Professor

Division of Infectious Diseases

Department of Medicine

UCSD Antiviral Research Center

Division of Family Medicine

Department of Family and Preventive Medicine

UCSD La Jolla Family and Sports Medicine

San Diego

CA

Disclosures

SM has received funding from NIH, CHRP, CIRM, and Gilead Sciences. SM is an author of a number of references cited in this monograph.

Peer reviewers VIEW ALL

Associate Professor

Ob/Gyn and Urology

Director

Division of Urogynecology

Associate Residency Program Director

Temple University Hospital

Philadelphia

PA

Disclosures

VD declares that he has no competing interests.

Consultant in Genitourinary and HIV Medicine

Archway Centre & Mortimer Market Centre

London

UK

Disclosures

EJ declares that she has no competing interests.

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