小结
Definição
História e exame físico
Principais fatores diagnósticos
- urethral discharge
- urethral irritation or itching
- dysuria
Outros fatores diagnósticos
- orchialgia
- absence of epididymal tenderness and/or swelling
- absence of pelvic pain (women)
- absence of pustular or petechial rash
- absence of arthritis
- absence of eye inflammation
Fatores de risco
- ages 15 to 24 years
- female sex
- men who have sex with men
- new or multiple sex partners
- prior or current STI
- inconsistent condom use
- circumcision
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- Gram stain of urethral discharge and/or urine sediment
- nucleic acid amplification tests (NAAT)
- culture of urethral discharge
- potassium hydroxide prep of urethral discharge
- HIV test
- syphilis test
Investigações a serem consideradas
- urinalysis and culture
- wet mount of urethral discharge (women)
- NAAT and culture of urine or urethral/vaginal swab for Trichomonas vaginalis
- NAAT for other organisms
Algoritmo de tratamento
initial Gram stain suggestive of gonorrhea: nonpregnant
initial Gram stain suggestive of gonorrhea: pregnant
initial Gram stain not suggestive of gonorrhea: nonpregnant
initial Gram stain not suggestive of gonorrhea: pregnant
recurrent or resistant urethritis
Colaboradores
Autores
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
CA
Declarações
SM has received funding from NIH, CHRP, CIRM, NASA, and Visby Medical. SM owns stock in Bristol Myers Squib and is the founder of Aspera Biomedicines. SM is an author of a number of references cited in this topic.
Agradecimentos
Dr Sheldon Morris would like to gratefully acknowledge Dr Christina Bailey, a previous contributor to this topic.
Declarações
CB declares that she has no competing interests.
Revisores
Vani Dandolu, MD, MPH
Associate Professor
Ob/Gyn and Urology
Director
Division of Urogynecology
Associate Residency Program Director
Temple University Hospital
Philadelphia
PA
Declarações
VD declares that he has no competing interests.
Khalil Ghanem, MD, PhD
Assistant Professor of Medicine
Associate Fellowship Program Director
Division of Infectious Diseases
Johns Hopkins University School of Medicine
Baltimore
MD
Declarações
KG declares that he has no competing interests.
Christopher Fairley, PhD
Professor of Sexual Health
University of Melbourne
Director
Melbourne Sexual Health Centre
Carlton
Victoria
Australia
Declarações
CF is an author of a number of references cited in this topic. CF has received program grants of 6 figures US$.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
Referências
Principais artigos
Centers for Disease Control and Prevention. Sexually transmitted infections treatment guidelines, 2021. Jul 2021 [internet publication].Texto completo
Centers for Disease Control and Prevention. National overview of STIs in 2023. Nov 2024 [internet publication].Texto completo
European Association of Urology. Guidelines on urological infections. 2023 [internet publication].Texto completo
Horner PJ, Blee K, Falk L, et al; International Union against Sexually Transmitted Infections. 2016 European guideline on the management of non-gonococcal urethritis. Int J STD AIDS. 2016 Oct;27(11):928-37.Texto completo
British Association for Sexual Health and HIV. Urethritis and cervicitis. May 2023 [internet publication].Texto completo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Differentials
- Urinary tract infection
- Candida balanitis or vaginitis
- Noninfectious urethritis
Mais Diagnósticos diferenciaisGuidelines
- Guidelines on urological infections
- 2021 European guideline on Mycoplasma genitalium infections
Mais GuidelinesPatient information
Chlamydia
Gonorrhea
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