Urethritis medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Medical Therapy

Treatment should be initiated as soon as possible after diagnosis.

Pharmacotherapy

A variety of drugs may be prescribed based on the cause of the patient's urethritis. Some examples of medications based on causes include:

• Clotrimazole (Mycelex) - Trichomonas
• Doxycycline (Vibramycin) - Chlamydia
• Fluconazole (Diflucan) - Monilial
• Metronidazole (Flagyl) - Trichomonas
• Nitrofurantoin - Bacterial Infection
• Nystatin (Mycostatin) - Monilial
• Co-trimoxazole, which is a combination of Sulfamethoxazole and Trimethoprim in a ratio of 5 to 1 (Septrin, Bactrim) - Bacterial Infection

Nongonococcal Urethritis Treatment

Azithromycin and doxycycline are highly effective for chlamydial urethritis; however, infections with M. genitalium respond better to azithromycin (249,250). Single-dose regimens have the advantage of improved compliance and directly observed treatment. To maximize compliance with recommended therapies, medications should be dispensed on-site in the clinic, and the first dose should be directly observed.

Nongonococcal Urethritis Treatment Preferred Regimen ▸ Doxycycline 100 mg bid po x 7 days OR ▸Azithromycin 1 gm po as single dose Pregnancy ▸ Erythromycin 500 mg po qid x 7 days OR ▸Amoxicillin 500 mg po tid x 7 days Alternative Regimen ▸ Erythromycin 500 mg qid po x 7 days OR ▸Ofloxacin 300 mg q12h po x 7 days OR ▸Levofloxacin 500 mg q24h x 7 days Pregnancy ▸ Azithromycin 1 gm po single dose

Gonococcal Urethritis Treatment

Gonococcal Urethritis Treatment Preferred Regimen‡ ▸ Ceftriaxone 250 mg IM x 1 dose PLUS ▸ Azithromycin 1 gm PO x 1 dose for 7 days OR Doxycycline 100 mg po q12h for 7 days Alternative Regimen ▸ Azithromycin 2 gm po x 1 dose OR Cephalosporins single dose ▸ Ceftizoxime 500 mg IM OR ▸ Cefotaxime 500 mg IM OR ▸ Cefoxitin 2 gm IM + Probenecid 1 gm po OR ▸ Cefixime 400 mg po¶ PLUS ▸ Azithromycin 1 gm PO x 1 doseORDoxycycline 100 mg po q12h x 7 days OR ▸ SpectinomycinNUS 2 gm IM x 1 dose Failure of treatment† ▸ Ceftriaxone 500 mg IM x 1 dose PLUS ▸ Azithromycin 2 gm po x 1dose

‡Use combination therapy even if NAAT test is negative for Chlamydiae.
†Treat sex partner, repeat NAAT test after 1 week of cure.
¶If IM cephalisporins are not available.

Proper perineal hygiene should be stressed. This includes avoiding use of vaginal deodarant sprays and proper wiping after urination and bowel movements. Intercourse should be avoided until symptoms subside.

Recurrent Urethritis

Recurrent Non-gonococal Urethritis Preferred Regimen ▸ Metronidazole 2 gm po single dose PLUS ▸ Azithromycin 1 gm po x 1 dose Alternative Regimen ▸ Tinidazole 2 gm po x 1 dose PLUS ▸ Azithromycin 1 gm po x 1 dose