Last reviewed: June 2020
Last updated: January  2018



History and exam

Key diagnostic factors

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

Other diagnostic factors

  • orchalgia
  • 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
  • KOH prep of urethral discharge
  • HIV test
  • VDRL
More 1st investigations to order

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 non-gonococcal, non-chlamydial organisms
More investigations to consider

Treatment algorithm


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

Dr Sheldon Morris would like to gratefully acknowledge Dr Christina Bailey, a previous contributor to this monograph. CB declares that she has no competing interests.

Peer reviewersVIEW ALL

Associate Professor

Ob/Gyn and Urology


Division of Urogynecology

Associate Residency Program Director

Temple University Hospital




VD declares that he has no competing interests.

Assistant Professor of Medicine

Associate Fellowship Program Director

Division of Infectious Diseases

Johns Hopkins University School of Medicine




KG declares that he has no competing interests.

Professor of Sexual Health

University of Melbourne


Melbourne Sexual Health Centre





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

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