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Urethritis Treatment & Management

  • Author: Martha K Terris, MD, FACS; Chief Editor: Edward David Kim, MD, FACS  more...
 
Updated: Jul 05, 2016
 

Medical Care

Symptoms of urethritis spontaneously resolve over time, regardless of treatment. Administer antibiotics to prevent morbidity and to reduce disease transmission to others. Treating sexual contacts also prevents reinfection of the index patient.

Antibiotic therapy should cover both gonococcal urethritis and nongonococcal urethritis (NGU). If concomitant treatment for NGU is not provided, the risk of postgonococcal urethritis is approximately 50%. The choice of antibiotics should be based on cost, adverse effects, effectiveness, and compliance. In most situations, optimal treatment is with single-dose therapy administered in the emergency department or the physician's office.

For treatment of NGU, the Centers for Disease Control and Prevention (CDC) currently recommends azithromycin, 1 g orally in a single dose, or doxycycline, 100 mg orally twice a day for 7 days. Alternative regimens include any of the following:

  • Erythromycin base 500 mg orally four times a day for 7 days
  • Erythromycin ethylsuccinate 800 mg orally four times a day for 7 days
  • Levofloxacin 500 mg orally once daily for 7 days
  • Ofloxacin 300 mg orally twice a day for 7 days

For uncomplicated gonococcal urethritis, the CDC recommends single doses of ceftriaxone, 250 mg IM, and azithromycin, 1 g orally; preferably, the two antibiotics should be administered should be administered simultaneously and under direct observation. If ceftriaxone is unavailable, cefixime, 400 mg orally in a single dose, can be substituted.[4]

Next

Activity

See the list below:

  • Instruct the patient to refrain from intercourse until all partners are treated.
  • Educate the patient about always using barrier devices when engaging in intercourse with multiple partners.
  • Inform patients that infections can spread by orogenital or genitoanal intercourse, even in the absence of penovaginal intercourse.
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Contributor Information and Disclosures
Author

Martha K Terris, MD, FACS Professor, Department of Surgery, Section of Urology, Director, Urology Residency Training Program, Medical College of Georgia; Professor, Department of Physician Assistants, Medical College of Georgia School of Allied Health; Chief, Section of Urology, Augusta Veterans Affairs Medical Center

Martha K Terris, MD, FACS is a member of the following medical societies: American Cancer Society, Association of Women Surgeons, American Society of Clinical Oncology, Society of Urology Chairpersons and Program Directors, Society of Women in Urology, Society of Government Service Urologists, American College of Surgeons, American Institute of Ultrasound in Medicine, American Urological Association, New York Academy of Sciences, Society of University Urologists

Disclosure: Nothing to disclose.

Coauthor(s)

Kamran P Sajadi, MD Assistant Professor, Urology, Oregon Health & Science University

Kamran P Sajadi, MD is a member of the following medical societies: American Urological Association, Endourological Society, Oregon Medical Association, Western Section of the American Urological Association, American Urogynecologic Society, Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Edward David Kim, MD, FACS Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center

Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, Tennessee Medical Association, Sexual Medicine Society of North America, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Repros.

Additional Contributors

Leonard Gabriel Gomella, MD, FACS The Bernard W Godwin Professor of Prostate Cancer Chairman, Department of Urology, Associate Director of Clinical Affairs, Kimmel Cancer Center, Jefferson Medical College of Thomas Jefferson University

Leonard Gabriel Gomella, MD, FACS is a member of the following medical societies: American Association for Cancer Research, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Urological Association, Sigma Xi, Society for Basic Urologic Research, Society of University Urologists, Society of Urologic Oncology

Disclosure: Received consulting fee from GSK for consulting; Received honoraria from Astra Zeneca for speaking and teaching; Received consulting fee from Watson Pharmaceuticals for consulting.

References
  1. Gillespie CW, Manhart LE, Lowens MS, Golden MR. Asymptomatic urethritis is common and is associated with characteristics that suggest sexually transmitted etiology. Sex Transm Dis. 2013 Mar. 40(3):271-4. [Medline].

  2. CDC Fact Sheet: Reported STDs in the United States: 2014. Centers for Disease Control and Prevention. Available at http://www.cdc.gov/std/stats14/default.htm. November 2015; Accessed: June 14, 2016.

  3. Berntsson M, Tunbäck P. Clinical and microscopic signs of cervicitis and urethritis: correlation with Chlamydia trachomatis infection in female STI patients. Acta Derm Venereol. 2013 Mar 27. 93(2):230-3. [Medline].

  4. [Guideline] Workowski KA. Centers for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines. Clin Infect Dis. 2015 Dec 15. 61 Suppl 8:S759-62. [Medline]. [Full Text].

  5. Johnson LF, Lewis DA. The effect of genital tract infections on HIV-1 shedding in the genital tract: a systematic review and meta-analysis. Sex Transm Dis. 2008 Nov. 35(11):946-59. [Medline].

  6. Mugo PM, Duncan S, Mwaniki SW, Thiong'o AN, Gichuru E, Okuku HS, et al. Cross-sectional survey of treatment practices for urethritis at pharmacies, private clinics and government health facilities in coastal Kenya: many missed opportunities for HIV prevention. Sex Transm Infect. 2013 May 22. [Medline].

  7. Bradshaw CS, Chen MY, Fairley CK. Persistence of Mycoplasma genitalium following azithromycin therapy. PLoS ONE. 2008. 3(11):e3618. [Medline]. [Full Text].

  8. Gunn RA, O'Brien CJ, Lee MA, Gilchick RA. Gonorrhea screening among men who have sex with men: value of multiple anatomic site testing, San Diego, California, 1997-2003. Sex Transm Dis. 2008 Oct. 35(10):845-8. [Medline].

  9. Lee YS, Lee KS. Chlamydia and male lower urinary tract diseases. Korean J Urol. 2013 Feb. 54(2):73-7. [Medline]. [Full Text].

  10. Cunningham KA, Beagley KW. Male genital tract chlamydial infection: implications for pathology and infertility. Biol Reprod. 2008 Aug. 79(2):180-9. [Medline].

  11. Manhart LE, Gillespie CW, Lowens MS, Khosropour CM, et al. Standard Treatment Regimens for Nongonococcal Urethritis Have Similar but Declining Cure Rates: A Randomized Controlled Trial. Clin Infect Dis. 2013 Jan 3. [Medline].

  12. Bachmann LH, Manhart LE, Martin DH, Seña AC, Dimitrakoff J, Jensen JS, et al. Advances in the Understanding and Treatment of Male Urethritis. Clin Infect Dis. 2015 Dec 15. 61 Suppl 8:S763-9. [Medline].

 
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