Urethritis Organism-Specific Therapy

Updated: Nov 07, 2019
Author: Thomas E Herchline, MD; Chief Editor: Michael Stuart Bronze, MD 

Specific Organisms and Therapeutic Regimens

Organism-specific therapeutic regimens for urethritis are provided below, including those for the following[1, 2, 3, 4] :

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

Neisseria gonorrhoeae (gonococcal urethritis):

  • Ceftriaxone 250 mg IM in a single dose (strongly preferred) plus
  • Azithromycin 1 g PO in a single dose or
  • Doxycycline 100 mg PO BID for 7 days (if allergic to azithromycin)

If ceftriaxone is not available:

  • Cefixime 400 mg PO in a single dose (patient should return in 1 week for a test-of-cure [5] )  plus
  • Azithromycin 1 g PO in a single dose or
  • Doxycycline 100 mg PO BID for 7 days  (if allergic to azithromycin)

If patient has a severe cephalosporin allergy:

  • Azithromycin 2 g PO in a single dose plus
  • Gemifloxacin 320 mg PO in a single dose or
  • Gentamicin 240 mg IM in a single dose

Chlamydia trachomatis:

Ureaplasma urealyticum:

  • Doxycycline 100 mg PO BID for 7d

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

Mycoplasma genitalium

  • Azithromycin 1 g PO, one dose, followed by 500 mg PO daily for 3d
  • Treatment failures should be re-treated with moxifloxacin 400 mg daily for 7d

Trichomonas vaginalis