Introduction: Sexually transmitted infections (STIs) continue to rise globally, posing a significant health challenge. This study investigated gender-specific differences in symptom reporting of urethritis, healthcare-seeking behavior, and diagnostic pathways among patients in a German urological practice. Methods: This prospective, observational study included 91 patients undergoing urethral swab testing due to specific symptoms in a urological practice. Participants completed a questionnaire covering symptom duration, pain intensity, quality of life, libido, and prior healthcare encounters. Microbiological analyses of urethral swabs and demographic data were collected. Statistical analyses compared gender-specific variables. Results: The cohort was predominantly male (74.7%). Pathogenic bacteria were found in 60.4% of cases, with STIs in 61.8% of positive results. Females reported significantly higher pain levels (p = 0.001), longer symptoms (p < 0.001), and greater impacts on quality of life and libido (p < 0.001). Women more frequently sought prior medical consultation, often primarily from a gynecologist, which may be a factor in the delay of STI specific diagnostics and, therefore, diagnosis. Discussion: This study highlights significant gender differences in urethritis symptoms and care pathways, emphasizing the need for higher awareness of STIs in primary care and gynecology to reduce delays and possible mistreatment.

1.
WHO
. Implementing the global health sector strategies on HIV, viral hepatitis and sexually transmitted infections, 2022–2030 | report on progress and gaps. 2024.
2.
WHO
.
WHO factsheet - sexually transmitted infections (STIs)
;
2019
[cited 2025 May 18]. Available from: https://www.who.int/en/news-room/fact-sheets/detail/sexually-transmitted-infections-(stis)
3.
WHO
.
Global progress report on HIV, viral hepatitis and sexually transmitted infections; 2021
;
2021
.
4.
ECDC
.
STI cases on the rise across Europe 2024
[cited 2025 May 18]. Available from: https://www.ecdc.europa.eu/en/news-events/sti-cases-rise-across-europe
5.
ECDC
.
Gonorrhoea annual epidemiological report for 2022
;
2024
.
6.
RKI
.
RKI - Meldepflichtige Krankheiten und Krankheitserreger
[cited 2025 May 18]. Available from: https://www.rki.de/DE/Themen/Infektionskrankheiten/Meldewesen/Meldepflicht/meldepflichtige-krankheiten-und-krankheitserreger-node.html
7.
Harrer
K
,
Knoll
T
.
Urethritis
.
Urol a Glance
.
2014
:
291
3
.
8.
Hakenberg
OW
,
Harke
N
,
Wagenlehner
F
.
Urethritis in men and women
.
Eur Urol Supplements
.
2017
;
16
(
4
):
144
8
.
9.
AWMF
. AWMF S2 Leitlinie: Sexuell übertragbare Infektionen (STI) - Beratung, Diagnostik und Therapie n.d [cited 2025 May 18]. Available from: https://register.awmf.org/assets/guidelines/059-006l_S2k_Sexuell-uebertragbare-Infektionen-Beratung-Diagnostik-Therapie-STI_2019-09-abgelaufen.pdf
10.
Raude
K
,
Röbel
C
,
Schmidt
S
,
Stolzenburg
JU
,
Beverungen
H
.
Gender-specific differences in urethral swabs: a retrospective single-centre analysis
.
Urol Int
.
2025
;
109
(
3
):
236
43
.
11.
Pieretti
S
,
Di Giannuario
A
,
Di Giovannandrea
R
,
Marzoli
F
,
Piccaro
G
,
Minosi
P
, et al
.
Gender differences in pain and its relief
.
Ann Ist Super Sanita
.
2016
;
52
(
2
):
184
9
.
12.
Bartley
EJ
,
Fillingim
RB
.
Sex differences in pain: a brief review of clinical and experimental findings
.
Br J Anaesth
.
2013
;
111
(
1
):
52
8
.
13.
Fillingim
RB
,
King
CD
,
Ribeiro-Dasilva
MC
,
Rahim-Williams
B
,
Riley
JL
.
Sex, gender, and pain: a review of recent clinical and experimental findings
.
J Pain
.
2009
;
10
(
5
):
447
85
.
14.
Bremer
V
,
Dudareva-Vizule
S
,
Buder
S
,
an der Heiden
M
,
Jansen
K
.
Sexuell übertragbare Infektionen in Deutschland: die aktuelle epidemiologische Lage
.
Bundesgesundheitsbl
.
2017
;
60
(
9
):
948
57
.
15.
Kreisel
KM
,
Spicknall
IH
,
Gargano
JW
,
Lewis
FMT
,
Lewis
RM
,
Markowitz
LE
, et al
.
Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2018
.
Sex Transm Dis
.
2021
;
48
(
4
):
208
14
.
16.
AWMF
.
S3-Leitlinie Urethritis “Management der Urethritis bei männlichen* Jugendlichen und Erwachsenen”
[cited 2025 May 18]. Available from: https://register.awmf.org/assets/guidelines/013-099l_S3_Management-Urethritis-maennliche-Jugendliche-Erwachsene_2025-02.pdf
17.
AWMF
.
AWMF S3-Leitlinie Epidemiologie, diagnostik, therapie, prävention und management unkomplizierter, bakterieller, ambulant erworbener Harnwegsinfektionen bei Erwachsenen (HWI)
;
2024
[cited 2025 May 18]. Available from: https://register.awmf.org/de/leitlinien/detail/043-044
18.
NICE
.
Urinary tract infections in adults
.
NICE
;
2023
.
19.
Hein
DC
,
Wagenlehner
FME
.
Current diagnosis and treatment of sexually transmitted infections
.
Urologe
.
2018
;
57
(
12
):
1436
44
.
20.
Lee
SS
,
Cheng
KF
,
Wong
NS
,
Kwan
CK
,
Lau
OC
,
Cheng
HF
, et al
.
Emergence of antibiotic-resistant Mycoplasma genitalium as the cause of non-gonococcal urethritis in male patients at a sexually transmitted infection clinic
.
Int J Antimicrob Agents
.
2022
;
59
(
2
):
106510
.
21.
Bundesministerium für wirtschaftliche Zusammenarbeit und Entwicklung (BMZ)
.
Strategie zur Eindämmung von HIV, Hepatitis B und C und anderen sexuell übertragbaren Infektionen
;
2016
.
22.
National Center for HIV, Viral Hepatitis, STD and TB Prevention (US). Sexually transmitted infections surveillance, 2022: National Overview. 2024.
23.
Heßling
A
,
Bode
H
. Jugendsexualität 2015. Die Perspektive der 14–25-Jährigen. Ergebnisse einer repräsentativen Wiederholungsbefragung. 2015.
24.
Ju
I
,
Ohs
J
,
Park
T
,
Hinsley
A
.
Interpersonal communication influence on health-protective behaviors amid the COVID-19 crisis
.
Health Commun
.
2023
;
38
(
3
):
468
79
.
25.
Wadham
E
,
Green
C
,
Debattista
J
,
Somerset
S
,
Sav
A
.
New digital media interventions for sexual health promotion among young people: a systematic review
.
Sex Health
.
2019
;
16
(
2
):
101
23
.
You do not currently have access to this content.