Urethritis in men

Urethritis in a man is an indicator that any female partner is at risk of pelvic inflammatory disease (PID). Mycoplasma genitalium is now a proven urethral pathogen. Its role in female disease is uncertain. Chlamydia trachomatis and Neisseria gonorrhoeae remain the most important causes of acute urethritis. Most men with urethral C.trachomatis or N.gonorrhoeae infections may be asymptomatic, minimally symptomatic or have an atypical presentation such as epididymitis. Most young women with PID have a male partner with subclinical non-gonococcal urethritis. Rarely is a major pathogen implicated in persistent urethritis. Tests for C. trachomatis DNA in urine may be able to replace the painful (and often avoided) swabbing process. Resistance to ciprofloxacin by the gonococcus has now become clinically significant. Azithromycin, as a one-off oral treatment, is an important advance in controlling chlamydia-related disease. (author abstract)