How is urethritis diagnosed?

Updated: Dec 18, 2020
  • Author: Dustin L Whitaker, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Previously, urethritis was diagnosed based on Gram stain of urethral discharge demonstrating ≥ 5 white blood cells (WBC) per high power field (hpf). More recent studies suggest that utilizing a threshold of ≥ 5 WBC hpf could miss a significant proportion of infections due to Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma genitalium. [23, 24] According to the current Centers for Disease Control and Prevention (CDC) guidelines, urethritis can be documented on the basis of any of the following signs or laboratory test results [4] :

  • Mucoid, mucopurulent, or purulent discharge on examination
  • Gram stain of urethral secretions demonstrating ≥ 2 WBC per oil immersion field on microscopy
  • Positive leukocyte esterace test from a first-void urine
  • Microscopic examination of sediment from a spun first-void urine demonstrating ≥ 10 WBC/hpf

All patients with urethritis should be tested for N gonorrhoeae and C trachomatis

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