Diagnosis and treatment of urethritis in men

Urethritis in men may be divided into gonococcal or non-gonococcal. These cannot be distinguished by symptoms and signs. Gram stain and culture remain the best methods for diagnosing uncomplicated lower genital tract gonorrhoea. Uncomplicated gonorrhoea responds to a single dose of a suitable antimicrobial, the choice of dose and drug depending on antimicrobial sensitivity. In non-gonococcal urethritis, Chlamydia trachomatis may be identified in up to 58% of cases by cell culture or antigen identification methods, such as immunofluorescence or enzyme assay, with cell culture being the gold standard. Chlamydia responds to a minimum 6-day course of a tetracycline or erythromycin, though longer courses are frequently prescribed. Resolution of symptoms, signs and evidence of urethritis may be a problem. Management of urethritis includes sexual partner notification, examination, investigation and treatment. Rapid accurate diagnosis and effective treatment are vital to prevent complications, to control spread, and to minimize the role of gonococci and chlamydia in the transmission of human immunodeficiency virus (HIV) infection.