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Aetiology

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Aetiology of urethritis can be divided into infectious or noninfectious causes.

Infectious urethritis is further divided into:

  • gonococcal urethritis
    • “classic” form of infective urethritis
    • caused by Neisseria gonorrhoeae (1)
  • non-gonococcal urethritis (NGU)
    • most often caused by either Chlamydia trachomatis or Mycoplasma genitalium
    • the two organisms are more likely to be detected in
      • younger patients with NGU, although this association is not as strong for M genitalium
      • those with a urethral discharge and/or dysuria
      • C. trachomatis and M. genitalium may be less common in men who have sex with men (MSM) than heterosexual men with NGU
      • M. genitalium has been associated with balano-posthitis and C. trachomatis with a circinate balanitis
    • both organisms infrequently coexist in the same individual with NGU, but dual infections have been identified in up to 10% of men in some studies (2)
    • less common – Trichomonas vaginalis, Gardnerella vaginalis, Ureaplasma urealyticum, herpes simplex virus (HSV), adenovirus (1)

In persistent/recurrent urethritis, aetiology is most likely to be multifactorial

  • an infectious agent is identified in less than 50% of cases
  • Mycoplasma genitalium is identified in 20–40%
  • C. trachomatis is reported in 10%–20% of men treated with azithromycin 1g
  • additionaly, U. urealyticum and T. vaginalis have also been implicated

Note:

  • the term nonspecific urethritis (NSU) should be not be used since it applies to nongonococcal, nonchlamydial urethritis and may result in confusion (1)

Reference:

  1. Hakenberg OW et al. Urethritis in men and women. European Urology Supplements. 2017;16:144-148

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