A sexually transmitted infection (STI) is generally considered to be the underlying cause of urethritis in most, (but not all), men. Ideally, urethritis should be managed in a service specializing in sexual health, or a general practice providing an enhanced sexual health service. The following recommendations apply to men who cannot access these services within a reasonable time frame, or are unwilling to attend.

• Try to persuade the man to attend an appropriate service. Explain this will provide:
• Care that is non-judgemental and confidential.
• Screening for STIs (such as HIV, syphilis, and hepatitis).
• Partner notification and treatment.
• Do not offer empirical treatment to the partners of men with urethritis without their prior assessment. For men with proven chlamydial or gonorrhoeal infection, see the CKS topics on Chlamydia - uncomplicated genital and Gonorrhoea for information on the management of their partners.
• Give advice (both verbal and written) about:
• The most likely cause of urethritis which is usually, but not always, due to an STI.
• Abstaining from sex (including oral sex) until 7 days after treatment if azithromycin is used or on completion of doxycycline treatment; and until symptoms have resolved and any partners have been treated.
• The importance of safer sexual practices in reducing the future risk of acquiring STIs (for example the use of condoms, minimizing the number of sexual partners).
• Not squeezing or massaging the urethra repeatedly, as this could lead to aggravation of symptoms.
• The broader health implications for the man and his partner if urethritis is left untreated (such as persistent symptoms, risk of infertility in women if the urethritis is due to an STI, spread of infection, and increased susceptibility to HIV infection).
• For more information and resources, see www.fpa.org.uk.