<i>Streptococcus urinalis:</i> A potential case of male urethritis caused by a novel pathogen

Urethritis is a frequent lower urinary tract infection often linked to sexually transmitted infections (STIs). While <i>Neisseria gonorrhoeae</i> and <i>Chlamydia trachomatis</i> are the main pathogens, other microorganisms such as <i>Mycoplasma genitalium</i>, <i>Trichomonas vaginalis</i>, and <i>Ureaplasma urealyticum</i> may also be involved. In over half of non-gonococcal urethritis (NGU) cases, no causative agent is identified. We present the case of a 37-year-old man with scrotal pain, painful ejaculation, dysuria, and urethral discharge following a single unprotected sexual encounter. Initial STI PCR was positive for <i>Ureaplasma urealyticum</i>, and azithromycin was prescribed. Symptoms persisted, and a urethral culture revealed <i>Streptococcus urinalis</i>, confirmed by MALDI-TOF MS and 16S rRNA sequencing. Gram staining showed numerous leukocytes and Gram-positive cocci in chains. A second urethral swab yielded the same organism. The isolate was fully susceptible to all tested antibiotics. Although <i>S. urinalis</i> has been described in urinary tract infections and sepsis, to our knowledge, this is the first reported case suggesting a possible role in male urethritis. While prostatitis or epididymitis cannot be ruled out, the repeated isolation of <i>S. urinalis</i> and persistent symptoms support its potential pathogenicity. This case adds to growing evidence implicating <i>S. urinalis</i> in genitourinary tract infections.