Last reviewed: 28 Oct 2021
Last updated: 22 Mar 2021



History and exam

Key diagnostic factors

  • presence of risk factors
  • urethral discharge in men
  • tenderness and/or swelling of the epididymis
  • mucopurulent or purulent exudate at the endocervix

Other diagnostic factors

  • pelvic pain in women
  • 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, petechiae, or necrotic) at extremities
  • polyarthritis
  • purpuric rash
  • positive Brudzinski's sign and Kernig's sign
  • seizures
  • focal cerebral signs
  • murmur
  • ophthalmia neonatorum
  • rhinitis
  • urethritis (infantile)
  • vaginitis

Risk factors

  • age 15 to 29 years
  • men who have sex with men (MSM)
  • black ancestry
  • current or prior history of STI
  • multiple recent sexual partners
  • inconsistent condom use
  • risk factors of partner
  • history of sexual or physical abuse
  • substance use
  • past incarceration
  • high morbidity community

Diagnostic investigations

1st investigations to order

  • nucleic acid amplification test (NAAT)
  • culture
  • urinalysis in men
  • Gram stain of urine sediment
  • Gram strain of urethral discharge
  • HIV test
  • syphilis test

Treatment algorithm



Sheldon Morris, MD, MPH

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



SM has completed a National Institutes of Health contract for research study on the Visby Medical Sexual Health Test. SM is an author of a number of references cited in this topic.

Peer reviewers

Vani Dandolu, MD, MPH

Associate Professor

Ob/Gyn and Urology


Division of Urogynecology

Associate Residency Program Director

Temple University Hospital




VD declares that he has no competing interests.

Eva Jungmann, FRCP MSc

Consultant in Genitourinary and HIV Medicine

Archway Centre & Mortimer Market Centre




EJ declares that she has no competing interests.

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