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Urethritis - male - Making a diagnosis
How do I know my patient has it?
- Suspect urethritis if the man has:
- Urethral discharge (this may not be noticed by the man and may only be observable on examination), or
- Dysuria or penile discomfort, and a risk of sexually transmitted infection (that is, he is sexually active, has had sex without a condom, or he has a recent new partner).
- In primary care, a diagnosis of urethritis is supported by:
- The presence of urethral discharge [CDC, 2006; Coble et al, 2006], and
- A first-void urine sample testing positive for leucocyte esterase (a reading of 1+ or greater) or showing the presence of urinary threads [Munday et al, 1981].
- To confirm a diagnosis of urethritis, take either a urethral swab or first-void urine sample, and send for microscopy to identify polymorphonuclear (PMNL) cells.
- A urethral smear containing five PMNL cells or more per high-power microscopic field, and/or a first-void urine sample containing 10 PMNL cells or more per high-power microscopic field confirms a diagnosis of urethritis.
- Either test may produce a false-negative result. Conducting both tests will reduce the risk of missing true positive cases [BASHH, 2007].
[BASHH, 2007; European Association of Urology, 2009]
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