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Urethritis can be diagnosed if any of the following criteria are present:

  • Visible mucopurulent or purulent urethral discharge
  • Gram stain of urethral secretions showing more than four leukocytes per oil immersion field
  • Positive leukocyte esterase test on first-void urine
  • First-void urine with more than nine leukocytes per high-power field

The CDC considers Gram stain to be the best rapid test for diagnosing urethritis. Demonstration of gram-negative intracellular diplococci has 99.6% correlation with Gen-Probe for N. gonorrhoeaea. However, many clinicians do not have office-based Gram stain capabilities. If none of the above criteria are met, treatment can be deferred pending the results of specific testing for N. gonorrhoeae and C. trachomatis. But many clinicians will initiate empiric treatment at this point, especially if patient follow-up is questionable. Empiric treatment will cover some of those organisms that are not routinely cultured, such as M. hominis, M. genitalium, and U. urealyticum.

Nucleic acid amplification tests, which target and amplify sequences of DNA or RNA that are specific to N. gonorrhoeae or C. trachomatis, are easier, cheaper, and more sensitive than traditional culture methods. Amplification techniques include ligase chain reaction, polymerase chain reaction, and transcription-mediated amplification. Rapid 30-minute nucleic acid tests for office use are available but are not as sensitive as laboratory-based tests.

Testing first-void urine specimens may be slightly less sensitive than using urethral swab samples. However, many clinicians (and patients) prefer urine sampling for its ease of use. First-void urine sampling involves collecting the first 10 to 20 mL of a void. Patients should not have urinated for 30 to 60 minutes before the sample is collected.


Men's Health