Streptococcus pyogenes: An Unusual Cause of Urethritis

Nongonococcal urethritis is a very common infection in men. Though Streptococcus pyogenes has frequently been associated with other genital tract infections, it has very rarely been reported as a causative agent of urethritis. We report a case of a healthy 31-year-old man who presented to the emergency department with symptoms of urethritis and penile ulcers. Culture of both urine and urethral exudate were positive for S. pyogenes sensitive to penicillin. A swab of the ulcer was positive for herpes simplex virus 2. He was treated with a seven-day course of amoxicillin and acyclovir, with full resolution of symptoms. To the best of our knowledge, this is the first case report of S. pyogenes urethritis transmitted through sex between men. This organism is a possible and probably underreported agent of urethritis. This case underscores the importance of microbiological testing in the treatment of urethritis.