Last reviewed: 26 Aug 2021
Last updated: 23 Jun 2021

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • urethral discharge
  • urethral irritation or itching
  • dysuria

Other diagnostic factors

  • 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

Risk factors

  • age 15 to 24 years
  • female sex
  • men who have sex with men
  • low socio-economic status
  • new or multiple sex partners
  • prior or current STD
  • inconsistent condom use
  • circumcision

Diagnostic investigations

1st investigations to order

  • 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
  • Venereal Disease Research Laboratory

Investigations to consider

  • 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

Treatment algorithm

Contributors

Authors

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

Disclosures

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.

Acknowledgements

Dr Sheldon Morris would like to gratefully acknowledge Dr Christina Bailey, a previous contributor to this topic.

Disclosures

CB declares that she has no competing interests.

Peer reviewers

Vani Dandolu, MD, MPH

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.

Khalil Ghanem, MD, PhD

Assistant Professor of Medicine

Associate Fellowship Program Director

Division of Infectious Diseases

Johns Hopkins University School of Medicine

Baltimore

MD

Disclosures

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

Disclosures

CF is an author of a number of references cited in this topic. CF has received programme grants of 6 figures US$.

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