When should I consider referring a patient with urethritis for specialist evaluation?

Consider referring a patient with urethritis for specialist evaluation if:

• They have recurrent or persistent urinary tract infections, which may indicate complicated lower urinary tract dysfunction requiring specialist assessment.
• There is suspicion of underlying serious pathology such as urological cancer, especially if symptoms persist despite initial treatment.
• Symptoms are severe, complicated, or do not respond to initial conservative or antibiotic treatment.
• There are associated symptoms such as haematuria, unexplained urinary tract symptoms, or other red flags that raise concern for malignancy or complex urological conditions.

Referral should be considered to ensure appropriate specialist investigations such as cystoscopy, imaging, or further urological evaluation can be performed.

In summary, refer patients with urethritis for specialist evaluation if they have persistent, recurrent, complicated infections, or if there is suspicion of cancer or other serious urological conditions.

References: NICE CG97, NICE NG12, NICE CG148