Supplementary Material for: Gender Differences in Urethral Swab Findings: A Prospective Study of Symptoms, Diagnosis and Treatments

Introduction
Sexually transmitted infections (STIs) continue to rise globally, posing a significant health challenge. This study investigates 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 (74.73%). Pathogenic bacteria were found in 60.44% of cases, with STIs in 61.82% 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 for STIs in primary care and gynecology to reduce delays and possible mistreatment.