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] Sujit Routray, M.D. [3]
Overview
Non-gonococcal urethritis is generally treated with either azithromycin or doxycyline.[1] For patients with gonococcal urethritis, the preferred regimen is either combination of ceftriaxone and azithromycin.
Medical Therapy
Antibiotic Therapy
| Disease | Treatment |
|---|---|
| Nongonococcal Urethritis | |
| Asthma | Presents with cough, dyspnea and wheezing and typically is a chronic condition which typically starts during childhood.[2] |
| Bronchiectasis | Presents copious purulent sputum, coarse crackles, clubbing and CT findings suggestive of bronchiectasis.[2] |
| Gastroesophageal Reflux Disease | May present with chronic dry cough but the typical symptom is heart burn.[3][4] |
| Congestive heart failure | Features with orthopnea, paroxysmal nocturnal dyspnea, fine crackles on auscultation and chest x-ray findings of cardiac enlargement and pulmonary congestion (Kerley B lines, and pleural effusion). |
- 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.
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.
- ↑ 2.0 2.1 Busse WW (2011). "Asthma diagnosis and treatment: filling in the information gaps". J. Allergy Clin. Immunol. 128 (4): 740–50. doi:10.1016/j.jaci.2011.08.014. PMID 21875745.
- ↑ Singh A (2009). "Asthma in older adults". CMAJ. 181 (12): 929. doi:10.1503/cmaj.109-2049. PMC 2789137. PMID 19969583.
- ↑ Irwin RS, Baumann MH, Bolser DC, Boulet LP, Braman SS, Brightling CE, Brown KK, Canning BJ, Chang AB, Dicpinigaitis PV, Eccles R, Glomb WB, Goldstein LB, Graham LM, Hargreave FE, Kvale PA, Lewis SZ, McCool FD, McCrory DC, Prakash UB, Pratter MR, Rosen MJ, Schulman E, Shannon JJ, Smith Hammond C, Tarlo SM (2006). "Diagnosis and management of cough executive summary: ACCP evidence-based clinical practice guidelines". Chest. 129 (1 Suppl): 1S–23S. doi:10.1378/chest.129.1_suppl.1S. PMC 3345522. PMID 16428686.