Infectious urethritis in men: etiology, epidemiology, diagnosis and treatment (analytical review)

Infectious urethritis in men is caused by various sexually transmitted pathogens, most often bacteria (Chlamydia trachomatis, Neisseria gonorrhoeae or Mycoplasma genitalium). It is impossible to differentiate the etiology and exclude the presence of combined ones based solely on clinical manifestations. Nevertheless, in clinical practice, empirical antibiotic therapy is often prescribed for suspected infectious urethritis before receiving the results of identifying the pathogen. In the context of globally increasing antibiotic resistance, it is important to consider the epidemiology of pathogens, drug susceptibility, and concomitant infections. The diagnosis of acute urethritis in men is suggested in the presence of at least one of the main clinical symptoms, excluding other possible causes. Typical manifestations include subjective symptoms (dysuria/alguria; burning, itching, pain in the area of the external urethral orifice) and objective clinical signs (urethral discharge). To confirm inflammation, microscopy of a smear from the urethra is recommended: detection of 5 or more polymorphonuclear leukocytes in the field of view is considered a diagnostic criterion for urethritis. Laboratory diagnosis for suspected infectious urethritis include: if urethral discharge is present, taking a urethral smear for microscopic examination, bacteriological culture, and determination of N. gonorrhoeae sensitivity to antibiotics; regardless of the presence of discharge, performing a nucleic acid amplification test to detect N. gonorrhoeae, C. trachomatis, and M. genitalium in a first-catch urine sample or in a urethral smear (scraping). The decision to initiate empirical antibiotic therapy for urethritis should be made individually, considering certain criteria (severity of symptoms, risk of complications, epidemiological data, etc.) in a patient. If gonococcal urethritis is suspected, ceftriaxone is recommended, if not — doxycycline is the recommended empirical treatment. The review provides detailed recommendations for the diagnosis and treatment of sexually transmitted infections causing infectious urethritis.