Introduction

Learning objectives

Recognize the clinical presentation of urethritis.
Differentiate the typical presentations of gonorrhea and Chlamydia, without relying on clinical findings alone.
Understand the current role of nucleic acid amplification techniques in diagnosis.

Video lesson

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Video pending upload (embedded YouTube)

Summary

What is urethritis?

It is inflammation of the urethra.

It may present with:

urethral discharge;
dysuria;
urethral itching or discomfort;
a sensation of irritation at the meatus.

However, some patients may be asymptomatic.

Two key pathogens

Neisseria gonorrhoeae → gonorrhea.

Chlamydia trachomatis → Chlamydia infection.

There are also other causes of urethritis.

Gonorrhea

It can cause an obvious urethral discharge, often purulent, accompanied by dysuria.

But the clinical presentation alone does not allow the microorganism to be identified with certainty.

Chlamydia

It can cause milder symptoms or remain asymptomatic.

It is particularly important because an undiagnosed infection can persist and be transmitted to others.

Diagnosis

Nucleic acid amplification techniques (NAAT/PCR) currently play a central role in detecting gonococcus and Chlamydia.

Depending on sexual practices, samples from different sites may be needed.

Treatment

Treatment should follow current recommendations and take into account:

suspected or identified microorganism;
antimicrobial resistance;
coinfections;
allergies;
local epidemiology.

Key concept

Urethral discharge + dysuria → think of urethritis and test especially for gonococcus and Chlamydia.

PDF

⬇ Download lesson summary

Downloadable PDF pending upload.

Practical algorithm

Urethral discharge + dysuria → think of urethritis → gonococcus/Chlamydia among the main causes.
Painless genital ulcer → consider syphilis.
Painful vesicles or ulcers → consider genital herpes.
Anogenital warts → consider HPV/condylomata.
Epididymal pain in a sexually active patient → consider STIs depending on age and context, but rule out torsion in an acute scrotum.
Diagnosis of an STI → consider testing for other STIs + partner management + prevention.
Recent high-risk HIV exposure → promptly assess the indication for PEP.

An STI is not managed only by treating the patient. The approach includes correct diagnosis, screening for coinfections when appropriate, partner management and prevention of further transmission.

Clinical case

Content pending upload Progressive clinical case focused on decision-making.

Self-assessment

Questions pending upload 5–10 multiple-choice questions on this lesson.

References

Links pending upload References to PubMed, DOI, scientific society guidelines and journals.

Urethritis: gonorrhea and Chlamydia