Snapshot A 22-year-old man presents to his primary care physician due to pain with urination and a burning sensation. The patient was in his usual state of health until 3 days prior to presentation. He reports to having unprotected sex for the past few weeks. On physical examination, there is purulent discharge at the urethral meatus. The patient receives a single intramuscular injection of ceftriaxone with a 1 day course of oral azithromycin. Introduction Clinical definition urethritis describes inflammation of the urethra Epidemiology incidence gonococcal urethritis login to view 2 more bullets nongonococcal urethritis login to view 1 more bullet demographics most commonly occurs in sexually active young men login to view 1 more bullet risk factors sexual activity Etiology microbial infection such as N. gonorrhoeae C. trachomatis M. genitalium viruses such as herpes simplex virus Pathogenesis bacterial invasion results in an inflammatory response Prognosis favorable for gonococcal or nongonococcal urethritis when treated appropriately Presentation Symptoms dysuria pruritis burning sensation Physical exam discharge from the urethral meatus urethral meatus may appear inflamed Studies Labs first-void or first-catch urine a positive leukocyte esterase on urine dipstick or having ≥ 10 WBC/hpf on microscopy is suggestive of urethritis nucleic acid amplification tests allows for the specific identification of the offending organism such as login to view 3 more bullets Gram stain ≥ 2 WBC/hpf organisms may or may not be present login to view 2 more bullets Differential Cystitis Epididymitis Prostatitis Treatment Medical intramuscular ceftriaxone and oral azithromycin indications login to view 6 more bullets oral azithromycin or doxycycline indications login to view 2 more bullets Complications Gonococcal urethritis gonococcal prostatitis and pharyngitis acute epididymitis disseminated gonococcal infection infectious conjunctivitis Nongonococcal urethritis acute epididymitis postinflammatory reactive arthritis (formerly known as Reiter's arthritis) triad login to view 3 more bullets