Urethritis
Urethritis is inflammation of the urethra, classified as gonococcal or non-gonococcal, per the CDC Sexually Transmitted Infections Treatment Guidelines, 2021.
Symptoms
Discharge, burning with urination, and urethral itching or discomfort; some cases, especially non-gonococcal ones, are mild or nearly asymptomatic.
Causes and risk
Gonorrhea and chlamydia are the two most common causes; risk rises with new or multiple sex partners and inconsistent condom use.
How it is evaluated
NAAT testing, with first-catch urine as the preferred specimen, identifies the specific organism per CDC guidance.
Treatment
Ceftriaxone monotherapy is now first-line for gonorrhea (with doxycycline added only if chlamydia hasn't been excluded), replacing the older routine dual-therapy approach. Non-gonococcal urethritis and chlamydia are treated with doxycycline for 7 days, with azithromycin as an alternative preferred in pregnancy. Partners from the last 60 days should also be treated. Because gonorrhea treatment requires an injection, a positive test means an in-person visit is needed even after a telehealth evaluation.
When to seek care
Testicular pain and swelling, pelvic pain, fever, or spreading joint pain and rash can signal a complication (epididymitis, pelvic inflammatory disease, or disseminated infection) and need prompt care.