Urethritis medical therapy: Difference between revisions
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| style="padding: 7px 7px; background: #DCDCDC;" |'''Nongonococcal Urethritis''' | | style="padding: 7px 7px; background: #DCDCDC;" |'''Nongonococcal Urethritis''' | ||
| style="padding: 7px 7px; background: #F5F5DC;" |Preferred: | | style="padding: 7px 7px; background: #F5F5DC;" |Preferred: | ||
::::[[Azithromycin]] 1 g PO in a single dose | :::::[[Azithromycin]] 1 g PO in a single dose | ||
::::::::'''OR''' | :::::::::'''OR''' | ||
::::[[Doxycycline]] 100 mg PO bid for 7 days | :::::[[Doxycycline]] 100 mg PO bid for 7 days | ||
Alternatives: | Alternatives: | ||
::::[[Erythromycin]] base 500 mg PO qid for 7 days | :::::[[Erythromycin]] base 500 mg PO qid for 7 days | ||
::::[[Erythromycin ethylsuccinate]] 800 mg PO qid for 7 days | :::::[[Erythromycin ethylsuccinate]] 800 mg PO qid for 7 days | ||
::::[[Levofloxacin]] 500 mg PO qd for 7 days | :::::[[Levofloxacin]] 500 mg PO qd for 7 days | ||
::::[[Ofloxacin]] 300 mg PO bid for 7 days | :::::[[Ofloxacin]] 300 mg PO bid for 7 days | ||
|- | |- | ||
| style="padding: 7px 7px; background: #DCDCDC;" | '''Gonococcal Urethritis''' | | style="padding: 7px 7px; background: #DCDCDC;" | '''Gonococcal Urethritis''' | ||
| style="padding: 7px 7px; background: #F5F5DC;" |Preferred: | | style="padding: 7px 7px; background: #F5F5DC;" |Preferred: | ||
::::[[Ceftriaxone]] 250 mg IM in a single dose | :::::[[Ceftriaxone]] 250 mg IM in a single dose | ||
::::::::'''PLUS''' | :::::::::'''PLUS''' | ||
::::[[Azithromycin]] 1 g PO in a single dose | :::::[[Azithromycin]] 1 g PO in a single dose | ||
Alternative: | Alternative: | ||
::::[[Cefixime]] 400 mg PO in a single dose | :::::[[Cefixime]] 400 mg PO in a single dose | ||
::::::::'''PLUS''' | :::::::::'''PLUS''' | ||
::::[[Azithromycin]] 1 g PO in a single dose | :::::[[Azithromycin]] 1 g PO in a single dose | ||
|- | |- | ||
| style="padding: 7px 7px; background: #DCDCDC;" | '''Recurrent and Persistent Urethritis''' | | style="padding: 7px 7px; background: #DCDCDC;" | '''Recurrent and Persistent Urethritis''' | ||
| style="padding: 7px 7px; background: #F5F5DC;" | | | style="padding: 7px 7px; background: #F5F5DC;" | | ||
::::[[Metronidazole]] 2 g PO in a single dose | :::::[[Metronidazole]] 2 g PO in a single dose | ||
::::::::''or'' | :::::::::''or'' | ||
::::[[Tinidazole]] 2 g PO in a single dose | :::::[[Tinidazole]] 2 g PO in a single dose | ||
::::::::'''PLUS''' | :::::::::'''PLUS''' | ||
::::[[Azithromycin]] 1 g PO in a single dose | :::::[[Azithromycin]] 1 g PO in a single dose | ||
|- | |- | ||
|} | |} | ||
Revision as of 14:00, 4 October 2016
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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
Once the diagnosis is confirmed the appropriate antibiotic regimen should started to reduce the risk of complications.[1]. The standard of choice is described below.
Medical Therapy
Antibiotic Therapy
| Disease | Treatment |
|---|---|
| Nongonococcal Urethritis | Preferred:
Alternatives:
|
| Gonococcal Urethritis | Preferred:
Alternative:
|
| Recurrent and Persistent Urethritis |
|
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.