Urethritis Treatment & Management
- Author: Martha K Terris, MD, FACS; Chief Editor: Edward David Kim, MD, FACS more...
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.
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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