Urethritis usually manifests as dysuria, urethral discharge, or both. The discharge may be prominent enough to be the chief complaint or may have to be milked from the urethra.
The major causes of urethritis are N. gonorrhoeae and C. trachomatis, followed by Ureaplasma urealyticum and herpes simplex virus. Infection with more than one organism iscommon, particularly dual gonococcal and chlamydial infection. Up to 20% of cases haveno established etiology but are probably infectious.
The diagnosis of gonorrhea is established primarily by culture, although direct examinations(Gram stain, DNA assays) may suffice in symptomatic patients. DNA-based assays are comparable to culture for screening. Newly developed nonculture techniques (eg, DNA amplification) are superior to culture for C. trachomatis, while culture is the most appropriate test for herpes simplex virus. Treatment depends on the etiologicagent and whether the disease has progressed beyond the local site. Empiric regimensare directed at the two most common causes, N. gonorrhoeae and C. trachomatis. Incases of gonorrhea, concurrent treatment for chlamydia is recommended, unless the latterhas been specifically excluded. In general, the same approach is followed for epididymitisand cervicitis.