Introduction

Male urethritis

Gonococcal urethritis

Non-gonococcal urethritis

Chlamydial urethritis

Non-chlamydial non-gonococcal urethritis

Declaration of Competing Interest

References

Article Info

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Sexually transmitted infections (STIs) are infectious diseases transmitted by sexual activities in the broad sense. Common STIs are urethritis in males and cervicitis in females. STIs also include diseases that cause skin lesions around the genitalia such as genital herpes, syphilis, condyloma acuminatum, and phthiriasis pubis. In addition, causative agents of STIs have recently been detected also in extragenital areas such as the rectum, pharynx, and conjunctiva due to increased diversity of sexual practice including oral sex and occasionally cause symptoms. Urethritis and cervicitis are frequently caused by Neisseria gonorrhoeae and Chlamydia trachomatis, and gonococcal urethritis and cervicitis and chlamydial urethritis and cervicitis have been used as terms to indicate these conditions. Recently, the concept of urethritis and cervicitis caused by microorganisms other than N. gonorrhoeae and C. trachomatis has been recognized. Particularly, in males, the term nonchlamydial non-gonococcal urethritis has begun to be used for conditions in which neither gonococcus nor chlamydia is detected. Among such agents, the pathogenicity of Mycoplasma genitalium has been demonstrated [1]. Many patients with male urethritis exhibit severe symptoms and are often initiated to treat at the initial visit. Moreover, the percentage of gonococcal strains that are resistant to many kinds of antibiotics is increasing. Therefore, guidelines that can recommend drugs that are likely to cure these diseases are necessary.

The Japanese Association for Infectious Disease (JAID) and the Japanese Society of Chemotherapy (JSC) published the JAID/JSC Guide to Clinical Management of Infectious Disease 2011 in 2012, and a revised version in 2014 [2]. The treatments for STIs were summarized in these guides. However, it is difficult to show recommendation grades and evidence level of the literature concerning all such treatments in the guides. Here, this guideline for the diagnosis and treatment are presented with comments by focusing on male urethritis, which is the most frequent male STI and requires early treatment. Concerning the diagnosis and treatment for STIs, guidelines have been published by the Japanese Society for Sexually Transmitted Infections (JSSTI) [3], and this text has been prepared with maximum consistency with the JSSTI guidelines. However, it should be noted that there are some differences in matters including the selection of drugs concerning the items that have been newly clarified such as drug susceptibility of causative microorganisms of STIs.