History and exam
Key diagnostic factors
common
presence of risk factors
Key risk factors include age between 15 and 24 years, female sex, new or multiple sex partners, prior or current STD, and inconsistent use of condoms.
urethral discharge
Primary symptom of urethritis. The onset of symptoms occurs usually between 4 days and 2 weeks after contact with an infected partner.
urethral irritation or itching
An unexplained sensation of itching or irritation may be present between voids.
dysuria
A common symptom of gonococcal urethritis (GU) in men, and may precede discharge. Overall, dysuria is present in 73% to 88% of patients with GU.[2] In non-gonococcal urethritis, dysuria is slightly less common, occurring in 53% to 75% of patients. The presence of frequency or urgency suggests cystitis rather than urethritis.
Other diagnostic factors
common
orchialgia
A sensation of heaviness in the male genitals. If pain is present, it suggests epididymitis, orchitis, or both.
absence of epididymal tenderness and/or swelling
Presence suggests epididymitis or testicular torsion, rather than simple urethritis.
absence of pelvic pain (women)
Presence is more suggestive of urinary tract infection, endometritis, pelvic inflammatory disease, or more extensive disease.
absence of pustular or petechial rash
Pustular or petechial rash may be seen in untreated gonococcal urethritis that disseminates. Reactive arthritis syndrome should be considered if triad of urethritis, uveitis, and arthritis is present. Otherwise, rash is not seen with uncomplicated urethritis.
absence of arthritis
If present, more complicated disease exists. May be seen in reactive arthritis or disseminated gonococcal urethritis.
absence of eye inflammation
If present, more complicated disease exists. Infants born to mothers with urethritis and/or cervicitis may present with conjunctivitis and ophthalmia neonatorum. Uveitis in conjunction with reactive arthritis syndrome has also been described.
Risk factors
strong
aged 15 to 24 years
One of the strongest risk factors for disease acquisition. Infections with common causes of urethritis, Neisseria gonorrhoeae and Chlamydia trachomatis, are highest in this age group.[5]
female sex
Reported chlamydial infection in women in the US is considerably greater than the rate among men (610.7 per 100,000 and 368.3 per 100,000, respectively, in 2023).[5]
This is most likely to be a reflection of the fact that more women are screened for chlamydial infection.
men who have sex with men
new or multiple sex partners
People with multiple partners are more likely to have exposure to STIs and may be more prone to high-risk behaviours.[21]
prior or current STI
Co-infection with gonorrhoea and Chlamydia trachomatis occurs frequently (15% to 40% of cases of urethritis).[22]
inconsistent condom use
Proper and consistent condom use may prevent transmission of most of the causes of urethritis, and thus prevent infection.
weak
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