Urethritis

Primary prevention includes education of adolescents about safe sex practices, including abstinence. Once sexually active, all people should be educated about safe sex practices, encouraged to use condoms, and informed that limiting the number of sex partners can reduce the risk of infection.

• Patients should be instructed in safe sex practices. All sex partners within the last 60 days should be referred for evaluation and possible treatment. Use of prophylactic antibiotics is discouraged.[54]Martin DH, Bowie WR. Urethritis in males. In: Holmes KK, Sparling PF, Mardh P, et al., eds. Sexually transmitted diseases. 3rd ed. New York, NY: McGraw-Hill; 1999:833-45.[55]The British Association for Sexual Health and HIV. Position statement on doxycycline as prophylaxis for sexually transmitted infections 2021 update. Nov 2021 [internet publication]. https://www.bashhguidelines.org/position-statements/bashh-position-statement-on-doxycycline-as-prophylaxis-for-sexually-transmitted-infections-2021-update

• Studies have examined the practice of expedited partner therapy (where patients are given medication to treat sex partners). [ ] In people with sexually transmitted infections, what are the best strategies for partner notification?/cca.html?targetUrl=https://cochranelibrary.com/cca/doi/10.1002/cca.676/fullShow me the answer​ In the US, laws governing expedited partner therapy vary by state. Local health department should be contacted to determine the legality of this practice in each area.[1]Centers for Disease Control and Prevention. Sexually transmitted infections treatment guidelines, 2021. Jul 2021 [internet publication]. https://www.cdc.gov/std/treatment-guidelines/default.htm ​​[44]Hogben M. Partner notification for sexually transmitted diseases. Clin Infect Dis. 2007 Apr 1;44(suppl 3):S160-74. https://academic.oup.com/cid/article/44/Supplement_3/S160/496779 http://www.ncbi.nlm.nih.gov/pubmed/17342669?tool=bestpractice.com [45]Golden MR, Whittington WL, Handsfield HH, et al. Effect of expedited treatment of sex partners on recurrent or persistent gonorrhea or chlamydial infection. N Engl J Med. 2005 Feb 17;352(7):676-85. https://www.nejm.org/doi/10.1056/NEJMoa041681?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200www.ncbi.nlm.nih.gov http://www.ncbi.nlm.nih.gov/pubmed/15716561?tool=bestpractice.com [46]American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 737: expedited partner therapy. Obstet Gynecol. 2018 Jun;131(6):e190-3. https://journals.lww.com/greenjournal/Fulltext/2018/06000/Expedited_Partner_Therapy__ACOG_Committee_Opinion,.56.aspx http://www.ncbi.nlm.nih.gov/pubmed/29794679?tool=bestpractice.com ​ These programs are controversial because, while effective for reducing transmission of gonorrhea and chlamydial urethritis, they omit the opportunity to provide in-person contact, counseling, detection of other sexually transmitted infections (STIs), or detection of patient allergies.[47]Centers for Disease Control and Prevention. Sexually transmitted diseases: expedited partner therapy. April 2021 [internet publication]. https://www.cdc.gov/std/ept/default.htm

• People should be tested for other STIs, including HIV and syphilis. Patients who are given a specific diagnosis of chlamydia, gonorrhea, or trichomonas should be retested 3 months after treatment, as rates of reinfection are reported to be high, regardless of whether their sex partners were treated.

• Pregnant women should be retested to ensure cure, preferably with a nucleic acid amplification test such as ligase chain reaction or polymerase chain reaction of urethral discharge and/or urine sediment. Chlamydia test of cure is recommended 4 weeks after treatment, with a retest at 3 months. Retest for gonorrhea is recommended at 3 months.[1]Centers for Disease Control and Prevention. Sexually transmitted infections treatment guidelines, 2021. Jul 2021 [internet publication]. https://www.cdc.gov/std/treatment-guidelines/default.htm

• Prophylactic ocular antimicrobial medication is strongly recommended for all newborns exposed to Neisseria gonorrhoeae and is mandatory in most US states.[1]Centers for Disease Control and Prevention. Sexually transmitted infections treatment guidelines, 2021. Jul 2021 [internet publication]. https://www.cdc.gov/std/treatment-guidelines/default.htm

• Gonorrhea and chlamydia are reportable diseases per the Centers for Disease Control and Prevention, and practitioners should contact their local state health department for details.