Urethritis Empiric Therapy 

Updated: Feb 15, 2016
  • Author: Thomas E Herchline, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Empiric Therapy Regimens

Empiric therapeutic regimens for urethritis are outlined below, including those for the following [1, 2, 3, 4, 5, 6] :

  • Gonococcal and nongonococcal urethritis
  • Recurrent and persistent urethritis
  • Partners of patients with urethritis

If clinically-based diagnostic tools (eg, Gram-stain microscopy) are not available, treat patients with drug regimens effective against gonorrhea and Chlamydia, as follows:

  • Azithromycin 1 g PO in a single dose or  doxycycline 100 mg PO BID for 7d (contraindicated during pregnancy) plus
  • Ceftriaxone 250 mg IM in a single dose (strongly preferred) or cefixime 400 mg PO in a single dose (plus test-of-cure in 1 week)
  • Fluoroquinolones should not be used as empiric therapy because of increasing resistance of Neisseria gonorrhoeae isolates.

Nongonococcal urethritis

First-line regimens:

  • Azithromycin 1 g PO in a single dose or
  • Doxycycline 100 mg PO BID for 7d (contraindicated during pregnancy)

Alternative regimens:

Recurrent and persistent urethritis

Recommended regimens:

  • Metronidazole 2 g PO in a single dose or
  • Tinidazole 2 g PO in a single dose plus azithromycin 1 g PO in a single dose

Treatment recommendations for partners

Recommendations include the following:

  • Sexual partners (within the preceding 60 d) of patients treated for nongonococcal urethritis should be referred for evaluation and treatment 
  • Patients with Chlamydia trachomatis should be instructed to abstain from sexual intercourse until 7 d after single-dose therapy or until completion of a 7 d regimen
  • Patients with Neisseria gonorrhoeae should be instructed to abstain from sexual intercourse until 7 d after single-dose therapy