Logo
Scope

Common Sense Pathology

<< back


THE INVESTIGATION OF URETHRITIS AND URETHRAL DISCHARGE

Definition

Urethritis is inflammation of the urethra. Typical clinical manifestations include burning on urination, urethral discomfort or itching, and urethral discharge.

Initial laboratory investigations

At the very least, a brief history and physical examination are required to help exclude local (e.g. epididymitis, pelvic inflammatory disease) and systemic (e.g. disseminated gonorrhoea) complications.

If possible, use laboratory results to determine the definitive diagnosis because (1) it helps determine whether the partner should be treated (2) increases patient compliance and (3) it is cost effective.

Urethral swab for MCS + First void urine or urethral swab (in transport medium) for chlamydia PCR and gonococcal PCR (note that the antigen test using ELISA or DFA is significant less sensitive than PCR).

Other tests e.g. virus culture should only requested, if clinically indicated.

 

CAUSES

SPECIFIC LABORATORY TESTS

SPECIFIC PATHOGENS

 

Neisseria gonorrhoeae

Urethral swab for MCS or
First void urine sample for gonococcal PCR 

Chlamydia trachomatis

First void urine for chlamydia PCR or 
urethral swab in chlamydia transport medium for PCR
(note that the antigen test using ELISA or DFA is significant less sensitive than PCR).

Trichomonas vaginalis

Urethral swab for microscopy (wet mount and special stains).

Mycoplasma hominis

Urethral swab for culture

Ureaplasma urealyticum

Urethral swab for culture

Herpes simplex virus 

Collect swab from typical lesions (usually in the anterior meatus) and submit in viral transport medium for culture or PCR.
Serology
may be helpful in primary herpes simplex virus infection. Serology needs to be performed during clinical presentation and 6-8 weeks later in order to demonstrate serocon-version. (the serology profile during the acute phase reflects the immune status prior to infection) 

 

OTHERS

 

Reiter's syndrome

A clinical tetrad that includes urethritis, conjunctivitis, mucocutaneous lesions, and arthritis. Consider testing for serum HLA-B27

Urinary tract infection esp. Prostatitis

Pretreatment Midstreaum urine (MSU) for MCS Blood cultures

Atrophic urethritis in elderly
Foreign bodies
Soaps

 

Admin | Copyright 2016 NPG | Website terms of use | Privacy Policy   
Click here to visit e2 solutions