Urethritis Organism-Specific Therapy

Updated: Jul 31, 2023
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] :

  • 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:

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