Summary
Definition
History and exam
Key diagnostic 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 and Kernig 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
Contributors
Authors
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 the National Institutes of Health (Clinical and Healthcare Research Policy division), the California Institute for Regenerative Medicine, and Gilead Sciences. SM has financial interests in Impact Biomedicines (now Celgene) and Forty Seven Inc. SM is an author of a number of references cited in this topic.
Peer reviewers
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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