A 32-year-old male presents with complaints of persistent dysuria. The patient reports that symptoms began about four weeks ago. Physical exam is otherwise unremarkable. He reports a history of condomless vaginal sex with three partners in the last six months.  He was treated presumptively for gonorrhea and chlamydia one week ago by his primary care provider with intramuscular ceftriaxone 500 mg once and doxycycline 100 mg orally, twice daily for 7 days. He reports that he has not engaged in any sexual activity since symptoms began. Symptoms did not improve or resolve despite treatment and recent testing for testing for gonorrhea, chlamydia and trichomoniasis were negative.