Approach to the male patient with suspected urethritis

NAAT: nucleic acid amplification test; STI: sexually transmitted infection; WBC/hpf: white blood cells per high powered field.
* First-void urine refers to the initial portion of the first urine stream upon wakening. The more practical first-catch urine refers to the initial portion of the urine stream at least one hour after the most recent micturition. Both are collected without precleaning the urethral meatus, and the volume collected is limited to approximately 10 mL.
¶ Although urethritis is often treated empirically prior to the results of NAAT for specific organisms, this testing remains important for documentation of specific infections and facilitation of sex partner management. Some UpToDate authors also recommend NAAT for Mycoplasma genitalium at the initial presentation.
Δ A methylene blue or gentian violet stain is an alternative to the Gram stain and can be performed more rapidly.
◊ In areas of low prevalence of sexually transmitted infection (eg, in family planning clinics), a higher threshold of ≥5 WBC/hpf is used to make the diagnosis of urethritis.