After receiving a diagnosis of urethritis in men and starting treatment, many patients believe the problem has been resolved. However, for successful infection control and prevention of recurrences, mandatory evaluation and treatment of sexual partners, as well as follow-up, are required.
Persistent or recurrent symptoms of urethritis often occur due to reinfection, antimicrobial resistance of the causative pathogen, or involvement of other organisms such as Mycoplasma genitalium or Trichomonas vaginalis that were not covered by the initial treatment regimen.
One of the most important aspects of managing STIs in men presenting with urethritis is partner management. All individuals who had sexual contact with a patient diagnosed with N. gonorrhoeae, C. trachomatis, or T. vaginalis within the 60 days prior to diagnosis should be evaluated and presumptively treated. If the patient cannot recall partners from the past 60 days, the most recent sexual partner should be evaluated.
To reduce the risk of transmission, men with infectious urethritis should abstain from sexual activity for at least seven days after starting therapy (including single-dose regimens) and until symptoms have completely resolved.
After treatment of urethritis in men caused by N. gonorrhoeae, C. trachomatis, or T. vaginalis, there is a high risk of reinfection. Therefore, repeat testing (NAAT) for these pathogens is recommended three months after completion of treatment, regardless of whether sexual partners were treated.
Symptoms that persist or recur require re-evaluation. In this case, repeat urine PCR testing (NAAT) for N. gonorrhoeae and C. trachomatis should be performed, as well as, if available, testing for M. genitalium and T. vaginalis. Symptoms alone are not an indication for retreatment unless there is objective evidence of inflammation (for example, the presence of WBCs in urine). If the evaluation confirms ongoing urethritis and tests for other organisms are negative, Mycoplasma genitalium is often the underlying cause.
Successful cure of urethritis in men requires not only accurate diagnosis and appropriate therapy, but also mandatory partner management and follow-up. Routine repeat STI testing in men at three months is essential to prevent recurrences and limit the spread of hidden infections.