Skip to main content Accessibility help
  • Print publication year: 2008
  • Online publication date: December 2009

20 - Male Genitourinary Infections

from Part I - Systems



The male urinary tract is contiguous with the reproductive organs, so infections arising in the urethra, epididymis, testicle and prostate share common symptoms of dysuria, frequency, and urgency. In healthy young or middle-aged men presenting to the acute care setting, these symptoms are unlikely to be caused by simple cystitis and are usually attributable to sexually transmitted disease or prostatitis.



Urethritis affects about 4 million males in the United States each year. The peak incidence is in males age 20–24. It is most often a sexually transmitted disease, caused by Neisseria gonorrhoeae (gonococcal urethritis) or Chlamydia trachomatis (nongonococcal urethritis, NGU). Other nongonococcal causes include Ureaplasma urealyticum, Mycoplasma hominis, or Trichomonas vaginalis (see Chapter 18, Nonulcerative Sexually Transmitted Diseases). Rare infectious causes of urethritis include lymphogranuloma venereum, herpes genitalis, syphilis, mycobacterium, and adenovirus. Enteric species can cause urethral infection in patients who practice insertive anal intercourse or patients with urethral strictures who develop cystitis.

Clinical Features

Male patients with urethritis may present with dysuria, penile discharge, and a history of unprotected sexual contact (Table 20.1). However, up to half of men are asymptomatic and present only because they were referred by a sexual partner who was diagnosed with a sexually transmitted disease (STD). Gonococcal urethritis is more likely to be symptomatic than nongonococcal urethritis.

Differential Diagnosis

The differential includes postinstrumentation (traumatic) urethritis, cystitis, pyelonephritis, urethral stricture, and urethral foreign body.

Andriole, V T. Use of quinolones in treatment of prostatitis and lower urinary tract infections. Eur J Clin Microbiol Infect Dis 1991 Apr;10(4):342–50.
Black, C M, Marrazzo, J M, Johnson, R E, et al. Head-to-head multicenter comparison of DNA probe and nucleic acid amplification tests for Chlamydia trachomatis in women performed with an improved reference standard. J Clin Microbiol 2002;40:3757–63.
Brown, J M, Hammers, L W, Barton, J W, et al. Quantitative Doppler assessment of acute scrotal inflammation. Radiology 1995;197:427–31.
Centers for Disease Control and Prevention (CDC). Update to CDC's sexually transmitted diseases treatment guidelines, 2006: fluoroquinolones no longer recommended for treatment of gonococcal infections. MMWR 2007;56(14); 332–336.
Chorba T, Tao G, Irwin KL. Sexually transmitted diseases. In: Litwin, M S, Saigal, C S, eds. Urologic diseases in America. U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Washington, DC: U.S. Government Printing Office, 2004; NIH Publication No. 04–5512 [pp. 233–82].
Johnson, R E, Green, T A, Schachter, J, et al. Evaluation of nucleic acid amplification tests as reference tests for Chlamydia trachomatis infections in asymptomatic men. J Clin Microbiol 2000;38:4382–6.
Nickel, J C. Prostatitis: evolving management strategies. Urol Clin North Am 1999;26:737–51.
Pol, B, Ferrero, D V, Buck-Barrington, L, et al. Multicenter evaluation of the BDProbeTec ET System for detection of Chlamydia trachomatis and Neisseria gonorrhoeae in urine specimens, female endocervical swabs, and male urethral swabs. J Clin Microbiol 2001;39:1008–16.
Association for Genitourinary Medicine (AGUM), Medical Society for the Study of Venereal Disease (MSSVD). 2002 national guideline for the management of prostatitis. London: Association for Genitourinary Medicine (AGUM), Medical Society for the Study of Venereal Disease (MSSVD), 2002.
Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines, 2006. MMWR 2006;55(11):61–2.
Centers for Disease Control and Prevention (CDC). Sexually transmitted disease surveillance 2005 supplement, Gonococcal Isolate Surveillance Project (GISP) annual report 2005. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, January 2007.