Urethritis Organism-Specific Therapy

Organism-specific therapeutic regimens for urethritis are provided below, including those for the following ^{[1, 2, 3]} :

• Neisseria gonorrhoeae
• Chlamydia trachomatis
• Trichomonas vaginalis
• Mycoplasma genitalium
• Ureaplasma urealyticum
• Mycoplasma hominis

Neisseria gonorrhoeae (gonococcal urethritis):

• Ceftriaxone 500 mg IM (1g in patients weighing ≥150 kg)

If ceftriaxone is not available:

• Gentamicin 240 mg IM in a single dose plus azithromycin 2 g PO in a single dose or
• Cefixime 800 mg orally in a single dose (patient should return in 1 week for a test-of-cure ^[4] )

If patient has a severe cephalosporin allergy:

• Gentamicin 240 mg IM in a single dose plus azithromycin 2 g PO in a single dose

Chlamydia trachomatis:

• Doxycycline 100 mg PO BID for 7d or
• Azithromycin 1 g PO in a single dose or
• Levofloxacin 500 mg PO once daily for 7d

Mycoplasma genitalium

If macrolide sensitive:

• Doxycycline 100 mg PO BID for 7d, followed by azithromycin 1 g PO initial dose then 500 mg PO once daily for 3 additional days (2.5 g total)

If macrolide resistant:

• Doxycycline 100 mg PO BID for 7d followed by moxifloxacin 400 mg PO once daily for 7 d

If If M genitalium is detected by an approved nucleic acid amplification test (NAAT) but M genitalium resistance testing is not available:

•  Doxycycline 100 mg PO BID for 7d , followed by moxifloxacin 400 mg PO once daily for 7d

Trichomonas vaginalis

• Metronidazole 500 mg PO BID 7d in women; 2 g PO in a single dose in men ^[5] or
• Tinidazole 2 g PO in a single dose (women and men)

Ureaplasma urealyticum:

• Doxycycline 100 mg PO BID for 7d or
• Azithromycin 1 g PO in a single dose

Mycoplasma hominis:

• Azithromycin 1 g PO in a single dose or
• Doxycycline 100 mg PO BID for 7d or
• Erythromycin base 500 mg PO QID for 7d or
• Erythromycin ethylsuccinate 800 mg PO QID for 7d