Pts present with a mucopurulent urethral discharge that can usually be expressed by milking of the urethra; alternatively, a Gram's-stained smear of an anterior urethral specimen containing ≥5 PMNs/1000× field confirms the diagnosis.
- Centrifuged sediment of the day's first 20-30 mL of voided urine can be examined instead.
- N. gonorrhoeae can be presumptively identified if intracellular gram-negative diplococci are present in Gram's-stained samples.
- Early-morning, first-voided urine should be used in “multiplex” nucleic acid amplification tests (NAATs) for N. gonorrhoeae and C. trachomatis.
Treatment: Urethritis in MEN - Treatment should be given promptly, while test results are pending.
- - Unless these diseases have been excluded, gonorrhea is treated with a single dose of ceftriaxone (250 mg IM) plus azithromycin (1 g PO once), and Chlamydia infection is treated with azithromycin (1 g PO once) or doxycycline (100 mg bid for 7 days); azithromycin may be more effective for M. genitalium.
- - Sexual partners of the index case should receive the same treatment.
- For recurrent symptoms: With re-exposure, both pt and partner are re-treated. Without re-exposure, infection with T. vaginalis (with culture or NAATs of a urethral swab and early-morning, first-voided urine) or doxycycline-resistant M. genitalium or Ureaplasma should be considered; treatment with metronidazole or tinidazole (a single PO dose of 2 g) plus azithromycin (1 g PO once) is recommended, and the azithromycin component is especially important if this drug was not used for the primary episode.
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