Background: Non-gonococcal urethritis (NGU) in males is a sexually transmitted infection commonly caused by Chlamydia trachomatis and Mycoplasma genitalium. Herpes simplex virus (HSV) has been reported as a causative agent in NGU; however, little is known about its clinical characteristics.  
Aim: The study compared the clinical characteristics of men with HSV urethritis to those in men with chlamydial urethritis, and determined if there were any key differences.
Methods: We compared clinical and laboratory data from men diagnosed with PCR confirmed HSV urethritis with those diagnosed with PCR confirmed chlamydial urethritis, presenting to Melbourne Sexual Health Centre between 2000 to 2015.
Results: Eighty HSV urethritis cases were identified: 68% (95% CI: 58-78) were HSV type 1 and 32% (95% CI: 22-42) were HSV type 2.  Compared with chlamydial urethritis, men with HSV urethritis were significantly more likely to report severe dysuria (20% vs. 0%, p<0.01) or constitutional symptoms (15% vs. 0%, p<0.01) and significantly less likely to report urethral discharge (19% vs. 54%, p<0.01).  Men with HSV urethritis were significantly more likely to have meatitis (62% vs. 23%, p<0.01), genital ulceration (37% vs. 0%, p<0.01), and inguinal lymphadenopathy (30% vs. 0%, p<0.01).  
Discussion/conclusion: In our study men with HSV urethritis had distinctive clinical features, not usually associated with chlamydial urethritis: severe dysuria, constitutional symptoms, meatitis, genital ulceration and lymphadenopathy.  Clinicians should consider HSV when these are present.

Clinical characteristics of herpes simplex virus urethritis compaerd with chlamydia urethritis among men: a case control study