Urethritis medical therapy: Difference between revisions
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*[[HIV]] and [[syphilis]] should be tested in men with [[non-gonococcal urethritis|non-gonococcal urethritis]]. [[HIV]] transmission is facilitated by co-existing [[non-gonococcal urethritis|non-gonococcal urethritis]], however treatment of NGU is the same in [[HIV]] negative or positive [[patients]]. | *[[HIV]] and [[syphilis]] should be tested in men with [[non-gonococcal urethritis|non-gonococcal urethritis]]. [[HIV]] transmission is facilitated by co-existing [[non-gonococcal urethritis|non-gonococcal urethritis]], however treatment of NGU is the same in [[HIV]] negative or positive [[patients]]. | ||
*[[Patients]] should be instructed to return for evaluation if [[symptoms]] persist or recur after completion of [[therapy]]. these [[patients]] should also be tested for [[Mycoplasma genitalium]] and [[Trichomonas vaginalis]]. <ref name="pmid26042815">{{cite journal |vauthors=Workowski KA, Bolan GA |title=Sexually transmitted diseases treatment guidelines, 2015 |journal=MMWR Recomm Rep |volume=64 |issue=RR-03 |pages=1–137 |year=2015 |pmid=26042815 |doi= |url=}}</ref> | *[[Patients]] should be instructed to return for evaluation if [[symptoms]] persist or recur after completion of [[therapy]]. these [[patients]] should also be tested for [[Mycoplasma genitalium]] and [[Trichomonas vaginalis]]. <ref name="pmid26042815">{{cite journal |vauthors=Workowski KA, Bolan GA |title=Sexually transmitted diseases treatment guidelines, 2015 |journal=MMWR Recomm Rep |volume=64 |issue=RR-03 |pages=1–137 |year=2015 |pmid=26042815 |doi= |url=}}</ref> | ||
*Men should return after three months for re-testing to rule out [[re-infection]] especially if [[urethritis]] was due to [[chlamydia]], [[gonorrhea]], or [[trichomoniasis]]. | *Men should be recommended to return after three months for re-testing to rule out [[re-infection]] especially if [[urethritis]] was due to [[chlamydia]], [[gonorrhea]], or [[trichomoniasis]]. | ||
*[[Symptoms]] without [[signs]] or [[laboratory]] evidence of [[urethral inflammation]] are not sufficient for re-treatment. | *[[Symptoms]] without [[signs]] or [[laboratory]] evidence of [[urethral inflammation]] are not sufficient for re-treatment. | ||
*Possibilities of [[chronic prostatitis]]/[[chronic]] [[pelvic pain syndrome]] in [[male]] [[patients]] demonstrating persistent [[pain]] ([[perineal]], [[penile]], or [[pelvic]]), discomfort, irritating [[voiding]] [[symptoms]], [[pain]] during or after [[ejaculation]], or new onset [[premature ejaculation]] lasting for >3 months should be evaluated and if present, a [[[urology]] consult should be made.<ref name="pmid26042815">{{cite journal |vauthors=Workowski KA, Bolan GA |title=Sexually transmitted diseases treatment guidelines, 2015 |journal=MMWR Recomm Rep |volume=64 |issue=RR-03 |pages=1–137 |year=2015 |pmid=26042815 |doi= |url=}}</ref><ref name="pmid20353145">{{cite journal |vauthors=Brill JR |title=Diagnosis and treatment of urethritis in men |journal=Am Fam Physician |volume=81 |issue=7 |pages=873–8 |year=2010 |pmid=20353145 |doi= |url=}}</ref> | *Possibilities of [[chronic prostatitis]]/[[chronic]] [[pelvic pain syndrome]] in [[male]] [[patients]] demonstrating persistent [[pain]] ([[perineal]], [[penile]], or [[pelvic]]), discomfort, irritating [[voiding]] [[symptoms]], [[pain]] during or after [[ejaculation]], or new onset [[premature ejaculation]] lasting for >3 months should be evaluated and if present, a [[[urology]] consult should be made.<ref name="pmid26042815">{{cite journal |vauthors=Workowski KA, Bolan GA |title=Sexually transmitted diseases treatment guidelines, 2015 |journal=MMWR Recomm Rep |volume=64 |issue=RR-03 |pages=1–137 |year=2015 |pmid=26042815 |doi= |url=}}</ref><ref name="pmid20353145">{{cite journal |vauthors=Brill JR |title=Diagnosis and treatment of urethritis in men |journal=Am Fam Physician |volume=81 |issue=7 |pages=873–8 |year=2010 |pmid=20353145 |doi= |url=}}</ref> | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2], Cafer Zorkun, M.D., Ph.D. [3], Sujit Routray, M.D. [4]
Overview
Treatment is based on the causative pathogen. Presumptive treatment should be initiated while waiting for the diagnostic confirmation. Once the diagnosis is confirmed, the appropriate antibiotic regimen should be initiated to reduce the risk of complications. Azithromycin 1 g PO in a single dose or Doxycycline 100 mg PO bid for 7 days is administered to treat Non-gonococcal Urethritis. A combination of Ceftriaxone 250 mg IM in a single dose and Azithromycin 1 g PO in a single dose is recommended to treat gonococcal urethritis. Metronidazole 2 g PO in a single dose is used for patients with recurrent and persistent urethritis. Following treatment, patients should be instructed to return for evaluation if symptoms persist or recur after completion of therapy. 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, irritating voiding symptoms, pain during or after ejaculation, or new onset premature ejaculation lasting for >3 months. All sex partners within the preceding 60 days should be referred for evaluation, testing, and empiric treatment with a drug regimen effective against Chlamydia. Clinicians must report both chlamydia and gonorrhea to health departments.
Medical Therapy
- Once the diagnosis is confirmed, the appropriate antibiotic regimen should be initiated to reduce the risk of complications.[1]
- Erythromycin is no longer considered as an alternative choice for non-gonococcal urethritis due to its gastrointestinal side effect and number of doses required.
- Due to its lower efficacy levofloxacin is no longer alternatively used for non-gonococcal urethritis.
- The standard of choice is described below.[2][3][4]
Antibiotic Therapy
| Disease | Treatment |
|---|---|
| Non-gonococcal Urethritis | Recommended:
Alternatives:
|
| Gonococcal Urethritis | Recommended:
Alternative:
|
| Recurrent and Persistent Urethritis |
|
Follow-Up
- HIV and syphilis should be tested in men with non-gonococcal urethritis. HIV transmission is facilitated by co-existing non-gonococcal urethritis, however treatment of NGU is the same in HIV negative or positive patients.
- Patients should be instructed to return for evaluation if symptoms persist or recur after completion of therapy. these patients should also be tested for Mycoplasma genitalium and Trichomonas vaginalis. [3]
- Men should be recommended to return after three months for re-testing to rule out re-infection especially if urethritis was due to chlamydia, gonorrhea, or trichomoniasis.
- Symptoms without signs or laboratory evidence of urethral inflammation are not sufficient for re-treatment.
- Possibilities of chronic prostatitis/chronic pelvic pain syndrome in male patients demonstrating persistent pain (perineal, penile, or pelvic), discomfort, irritating voiding symptoms, pain during or after ejaculation, or new onset premature ejaculation lasting for >3 months should be evaluated and if present, a [[[urology]] consult should be made.[3][4]
- Clinicians must report both chlamydia and gonorrhea to health departments.
Treatment of Sexual Partners
- If expedited treatment is required and permissible by state law for the partner then, in chlamydia negative partners single 800 mg oral dose of cefixime is recommended. In patients where chlamydia is not excluded recommended therapy is single 800 mg oral dose of cefixime plus oral doxycycline 100 mg twice daily for 7 days.
- 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 infection is encouraged. 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.[3][4]
References
- ↑ Stamm WE, Hicks CB, Martin DH, Leone P, Hook EW, Cooper RH, Cohen MS, Batteiger BE, Workowski K, McCormack WM (1995). "Azithromycin for empirical treatment of the nongonococcal urethritis syndrome in men. A randomized double-blind study". JAMA. 274 (7): 545–9. PMID 7629982.
- ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 9781455748013.
- ↑ 3.0 3.1 3.2 3.3 Workowski KA, Bolan GA (2015). "Sexually transmitted diseases treatment guidelines, 2015". MMWR Recomm Rep. 64 (RR-03): 1–137. PMID 26042815.
- ↑ 4.0 4.1 4.2 Brill JR (2010). "Diagnosis and treatment of urethritis in men". Am Fam Physician. 81 (7): 873–8. PMID 20353145.