Urethritis medical therapy: Difference between revisions
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{{Urethritis}} | {{Urethritis}} | ||
{{CMG}}; {{AE}}{{CZ}}{{SR}} | {{CMG}}; {{AE}}{{CZ}} {{SR}} | ||
==Overview== | ==Overview== | ||
Antimicrobial therapy is indicated in urethritis. | Empiric Antimicrobial therapy is indicated in urethritis. Non-gonococcal urethritis is generally treated with either [[azithromycin]] or doxycyline. For patients with gonococcal urethritis, the preferred regimen is either combination of [[ceftriaxone]] and [[azithromycin]]. | ||
==Medical Therapy== | ==Medical Therapy== | ||
*All patients with urethritis should be treated empirically once the diagnosis is confirmed. | |||
===Antimicrobial Therapy=== | ===Antimicrobial Therapy=== | ||
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:* Alternative regimen (3): [[Levofloxacin]] 500 mg PO qd for 7 days | :* Alternative regimen (3): [[Levofloxacin]] 500 mg PO qd for 7 days | ||
:* Alternative regimen (4): [[Ofloxacin]] 300 mg PO bid for 7 days | :* Alternative regimen (4): [[Ofloxacin]] 300 mg PO bid for 7 days | ||
:*Note: HIV-positive patients with non-gonococcal urethritis should receive the same treatment regimen as those who are HIV-negative | |||
*2. '''Gonococcal Urethritis''' | *2. '''Gonococcal Urethritis''' | ||
:* Preferred regimen: [[Ceftriaxone]] 250 mg IM in a single dose {{and}} [[Azithromycin]] 1 g PO in a single dose | :* Preferred regimen: [[Ceftriaxone]] 250 mg IM in a single dose {{and}} [[Azithromycin]] 1 g PO in a single dose | ||
:* Alternative regimen: [[Cefixime]] 400 mg PO in a single dose {{and}} [[Azithromycin]] 1 g PO in a single dose (if ceftriaxone is not available) | :* Alternative regimen: [[Cefixime]] 400 mg PO in a single dose {{and}} [[Azithromycin]] 1 g PO in a single dose (if ceftriaxone is not available) | ||
*3. '''Recurrent and Persistent Urethritis''' | *3. '''Recurrent and Persistent Urethritis''' | ||
:* Preferred regimen: [[Metronidazole]] 2 g PO in a single dose {{or}} [[Tinidazole]] 2 g PO in a single dose {{and}} [[Azithromycin]] 1 g PO in a single dose for 7 days | :* Preferred regimen: ([[Metronidazole]] 2 g PO in a single dose {{or}} [[Tinidazole]] 2 g PO in a single dose) {{and}} [[Azithromycin]] 1 g PO in a single dose for 7 days | ||
:* Alternative regimen, ''M. genitalium'': [[Moxifloxacin]] 400 mg PO qd for 7 days | |||
===Follow-Up=== | ===Follow-Up=== | ||
*Patients should be instructed to return for evaluation if symptoms persist or recur after completion of therapy. | |||
*Symptoms alone, without documentation of signs or laboratory evidence of urethral inflammation, are not a sufficient basis for re-treatment. | |||
*Providers should be alert to the possibility of chronic prostatitis/chronic pelvic pain syndrome in male patients experiencing persistent pain (perineal, penile, or pelvic), discomfort, irritative voiding symptoms, pain during or after ejaculation, or new-onset premature ejaculation lasting for > 3 months. | |||
*Unless a patient’s symptoms persist or therapeutic noncompliance or reinfection is suspected, a test-of-cure (i.e., repeat testing 3–4 weeks after completing therapy) is not recommended for persons with documented ''Chlamydia'' or gonococcal infections who have received treatment with recommended or alternative regimens. However, because men with documented chlamydial or gonococcal infections have a high rate of reinfection within 6 months after treatment, repeat testing for all men diagnosed with ''Chlamydia'' or ''Gonorrhea'' is recommended 3–6 months after treatment, regardless of whether patients believe that their sex partners were treated. | |||
*In individuals who have persistent symptoms after treatment without signs and symptoms of urethritis, the efficacy of extended-duration antimicrobials has not been demonstrated. Individuals who have persistent or recurrent urethritis can be retreated with the initial regimen if they did not comply with the treatment regimen or if they were re-exposed to an untreated sex partner. Persistent urethritis after doxycycline treatment might be caused by doxycycline-resistant ''U. urealyticum'', ''M. genitalium'', or ''T. vaginalis''. | |||
===Treatment of Sexual Partners=== | |||
*All sex partners within the preceding 60 days should be referred for evaluation, testing, and empiric treatment with a drug regimen effective against Chlamydia. | |||
*A specific diagnosis might facilitate partner referral. Therefore, testing for gonorrhea and chlamydia is encouraged. Because a substantial proportion of female partners of males with non-chlamydial, non-gonococcal urethritis are infected with ''Chlamydia'', partner treatment is recommended for males with non-gonococcal urethritis regardless of whether a specific etiology is identified. | |||
A specific diagnosis might facilitate partner referral. Therefore, testing for gonorrhea and chlamydia is encouraged. Because a substantial proportion of female partners of males with | |||
==References== | ==References== | ||
Revision as of 15:54, 6 October 2015
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Urethritis Microchapters | |
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Diagnosis | |
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Treatment | |
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Case Studies | |
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Urethritis medical therapy On the Web | |
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American Roentgen Ray Society Images of Urethritis medical therapy | |
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Risk calculators and risk factors for Urethritis medical therapy | |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2] Sujit Routray, M.D. [3]
Overview
Empiric Antimicrobial therapy is indicated in urethritis. Non-gonococcal urethritis is generally treated with either azithromycin or doxycyline. For patients with gonococcal urethritis, the preferred regimen is either combination of ceftriaxone and azithromycin.
Medical Therapy
- All patients with urethritis should be treated empirically once the diagnosis is confirmed.
Antimicrobial Therapy
- 1. Nongonococcal Urethritis
- Preferred regimen: Azithromycin 1 g PO in a single dose OR Doxycycline 100 mg PO bid for 7 days
- Alternative regimen (1): Erythromycin base 500 mg PO qid for 7 days
- Alternative regimen (2): Erythromycin ethylsuccinate 800 mg PO qid for 7 days
- Alternative regimen (3): Levofloxacin 500 mg PO qd for 7 days
- Alternative regimen (4): Ofloxacin 300 mg PO bid for 7 days
- Note: HIV-positive patients with non-gonococcal urethritis should receive the same treatment regimen as those who are HIV-negative
- 2. Gonococcal Urethritis
- Preferred regimen: Ceftriaxone 250 mg IM in a single dose AND Azithromycin 1 g PO in a single dose
- Alternative regimen: Cefixime 400 mg PO in a single dose AND Azithromycin 1 g PO in a single dose (if ceftriaxone is not available)
- 3. Recurrent and Persistent Urethritis
- Preferred regimen: (Metronidazole 2 g PO in a single dose OR Tinidazole 2 g PO in a single dose) AND Azithromycin 1 g PO in a single dose for 7 days
- Alternative regimen, M. genitalium: Moxifloxacin 400 mg PO qd for 7 days
Follow-Up
- Patients should be instructed to return for evaluation if symptoms persist or recur after completion of therapy.
- Symptoms alone, without documentation of signs or laboratory evidence of urethral inflammation, are not a sufficient basis for re-treatment.
- Providers should be alert to the possibility of chronic prostatitis/chronic pelvic pain syndrome in male patients experiencing persistent pain (perineal, penile, or pelvic), discomfort, irritative voiding symptoms, pain during or after ejaculation, or new-onset premature ejaculation lasting for > 3 months.
- Unless a patient’s symptoms persist or therapeutic noncompliance or reinfection is suspected, a test-of-cure (i.e., repeat testing 3–4 weeks after completing therapy) is not recommended for persons with documented Chlamydia or gonococcal infections who have received treatment with recommended or alternative regimens. However, because men with documented chlamydial or gonococcal infections have a high rate of reinfection within 6 months after treatment, repeat testing for all men diagnosed with Chlamydia or Gonorrhea is recommended 3–6 months after treatment, regardless of whether patients believe that their sex partners were treated.
- In individuals who have persistent symptoms after treatment without signs and symptoms of urethritis, the efficacy of extended-duration antimicrobials has not been demonstrated. Individuals who have persistent or recurrent urethritis can be retreated with the initial regimen if they did not comply with the treatment regimen or if they were re-exposed to an untreated sex partner. Persistent urethritis after doxycycline treatment might be caused by doxycycline-resistant U. urealyticum, M. genitalium, or T. vaginalis.
Treatment of Sexual Partners
- All sex partners within the preceding 60 days should be referred for evaluation, testing, and empiric treatment with a drug regimen effective against Chlamydia.
- A specific diagnosis might facilitate partner referral. Therefore, testing for gonorrhea and chlamydia is encouraged. Because a substantial proportion of female partners of males with non-chlamydial, non-gonococcal urethritis are infected with Chlamydia, partner treatment is recommended for males with non-gonococcal urethritis regardless of whether a specific etiology is identified.