Urethritis and Sexually Transmitted Infections

Urethritis

Urethritis is inflammation of the urethra. Gonorrhea and chlamydia are common sexually transmitted causes, but non-infectious causes are also possible.

• Pain or burning during urination
• Discharge, pus, itching, or discomfort at the urethral opening
• Testicular pain or swelling

Urethritis: testing pathway

For male urethritis, we use a first-catch urine sample (the first part of the urine stream).

• Urinalysis is used to look for white blood cells and other signs of urethritis.
• When indicated, a nucleic acid amplification test (NAAT) is performed for gonorrhea and chlamydia.
• Blood tests for syphilis, HIV or hepatitis B may also be discussed according to the situation.
• Results: tests sent to an external laboratory are not available on the same day. We explain when and how you will receive the result.

Urethritis: treatment pathway

When the findings strongly suggest urethritis, treatment may be started before the laboratory result is available. When it is safe to wait, treatment is selected after reviewing the test result.

• Gonorrhea: an intramuscular Trobicin (spectinomycin) injection is given. Chlamydia: a single 1000 mg dose of azithromycin is taken at the clinic. Coinfection requires treatment for both.
• The final choice depends on the test result, infection site, allergies, possible pregnancy, kidney function and other patient factors.
• Persistent or recurrent symptoms are reassessed for adherence, reinfection and other causes such as Mycoplasma genitalium; repeat testing, culture or referral may be needed.
• Male partners can be tested at our clinic using first-catch urine NAAT for gonorrhea and chlamydia. Blood tests for syphilis, HIV and hepatitis B are added when indicated, and treatment is based on the examination and test results.
• For female partners, we generally recommend an obstetrics and gynecology visit because vaginal or cervical swab testing and assessment for pelvic inflammatory disease or pregnancy-related concerns may be appropriate. Testing is recommended even without symptoms.
• Depending on the infection and site, a test of cure is arranged. Retesting at about three months may be recommended to detect reinfection.

Syphilis and other sexually transmitted infections

STIs that may not cause urethral symptoms include syphilis, HIV, hepatitis B, genital herpes and genital warts. Testing is selected according to symptoms and the timing of possible exposure.

• Concern after sexual contact, even without symptoms
• A lump, sore, blister or wart on the genitals, mouth or anus
• A rash that may include the palms or soles
• A sexual partner has been diagnosed with an STI

Syphilis: symptoms, testing and treatment

Syphilis is caused by Treponema pallidum. Symptoms may improve or disappear without the infection being cured, and some people have no symptoms.

• Early symptoms may include a painless lump or sore on the genitals, mouth or anus, sometimes with swollen lymph nodes in the groin.
• Later, a rash with little or no pain or itching may appear across the body, including the palms and soles.
• Diagnosis is based on examination and antibody blood tests. Repeat testing may be needed when testing occurs too soon after exposure.
• Treatment uses an antibiotic such as penicillin according to the stage and clinical condition. Follow-up blood tests are needed, and partners may also need testing and treatment.

HIV infection

Some people develop fever, sore throat, a rash or other flu-like symptoms early after infection, while others have no symptoms for a long time. Symptoms alone cannot determine whether HIV is present.

HIV is diagnosed with blood testing. Testing too soon after exposure may need to be repeated. A reactive screening result requires confirmation and specialist follow-up. Antiretroviral therapy suppresses the virus and is continued long term.

Hepatitis B

Hepatitis B can be transmitted through blood and body fluids, including through sexual contact. Many people have no symptoms; acute infection may cause fatigue, loss of appetite, nausea, dark urine or jaundice.

Blood tests such as HBs antigen and liver-function tests are used. Further testing or specialist referral is arranged according to the result. Treatment depends on whether the infection is acute or chronic. Vaccination can prevent hepatitis B.

Genital herpes

Painful blisters or sores may appear on or around the genitals. Pain on urination, itching or swollen lymph nodes in the groin may occur. Symptoms can recur after the first episode improves.

Diagnosis is based mainly on the symptoms and examination of the lesions.

Oral treatment at our clinic: valaciclovir 500 mg is generally taken twice daily for 5 days. For a first episode or more severe symptoms, treatment may be extended for up to 10 days. Starting treatment early in the episode is important.

Topical treatment: vidarabine 3% ointment (Ara-A) is applied to the lesions several times a day. Oral antiviral treatment is the main treatment; ointment is used for mild localized lesions or as an adjunct rather than as the only treatment.

The medicine and dose are adjusted for kidney function, age, possible pregnancy and other individual factors. For recurrences occurring approximately 6 or more times a year, suppressive treatment with valaciclovir 500 mg once daily may be considered.

Genital warts (condyloma acuminatum)

Genital warts are caused by human papillomavirus (HPV). Small white, pink or brown growths can appear around the genitals or anus. They may cause little pain but can increase in number or cluster together.

Diagnosis is based on examination of the shape, location, size and number of lesions.

Treatment at our clinic: after local anaesthesia, the lesions are cauterized using a bipolar electrode, an electrosurgical medical device. Depending on the location, size and number of lesions, treatment may be divided over more than one visit.

Follow-up after treatment: at follow-up visits, we examine wound healing and check for bleeding, swelling, signs of infection, residual warts and recurrence. The timing of follow-up is tailored to the number of lesions and the condition of the treated area. Please also inspect the genital and perianal area during bathing or at another convenient time.

Recurrence is particularly common during the first 3 months after treatment. If you notice a new or enlarging wart, please return before the scheduled visit. Contact us promptly if bleeding does not stop, pain worsens, pus appears or you develop a fever.

Miyazaki Prefecture free anonymous HIV and syphilis screening

Nishimoto Clinic is listed by Miyazaki Prefecture as a participating medical institution in its limited-time HIV and syphilis screening campaign. The program is for people without symptoms and provides the two blood tests together, free of charge and anonymously.

• Period: September 1 through the end of December 2026; the program may end earlier if the available number of tests is reached.
• Advance booking is required. When calling, say that you want the free anonymous screening program.
• At the visit, a brief interview and blood draw are followed by an appointment for result disclosure.
• A test certificate is not issued. If symptoms, a positive result or another clinical need requires ordinary medical care, identification and medical fees may be required.

Partners and preventing reinfection

Depending on the infection, current or recent sexual partners may also need testing and treatment. Avoid sexual contact until you and the relevant partner or partners have completed the recommended care and your clinician says it is safe to resume.

Seek urgent care

High fever or chills, severe testicular pain or swelling, severe lower abdominal or pelvic pain, inability to pass urine, or symptoms during pregnancy require prompt assessment. Emergency care may be more appropriate outside clinic hours.

Authoritative information