Empiric Therapy Regimens

Empiric therapeutic regimens for urethritis are outlined below, including those for the following^[1]:

Gonococcal and nongonococcal urethritis
Recurrent and persistent urethritis
Partners of patients with urethritis

If clinically-based diagnostic tools (eg, Gram-stain microscopy) are not available, treat patients with drug regimens effective against gonorrhea and Chlamydia, as follows:

Ceftriaxone 500 mg IM in a single dose (1 g in patients weighing ≥150 kg) plus
Doxycycline 100 mg PO BID for 7d (contraindicated during pregnancy) or
Fluoroquinolones should not be used as empiric therapy because of increasing resistance of Neisseria gonorrhoeae isolates. ^[2]

Nongonococcal urethritis

First-line regimens:

Doxycycline 100 mg PO BID for 7d (contraindicated during pregnancy)

Alternative regimens:

Azithromycin 1 g PO in a single dose 1 g PO in a single dose or
Azithromycin 500 mg PO in a single dose; then 250 mg PO daily for 4d

Recurrent and persistent urethritis

Recommended regimens:

Metronidazole 2 g PO in a single dose or
Tinidazole 2 g PO in a single dose plus azithromycin 1 g PO in a single dose

Treatment recommendations for partners

Recommendations include the following:

Sexual partners (within the preceding 60 d) of patients treated for nongonococcal urethritis should be referred for evaluation and treatment.
Patients with Chlamydia trachomatis should be instructed to abstain from sexual intercourse until 7 d after single-dose therapy or until completion of a 7 d regimen.
Patients with N gonorrhoeae should be instructed to abstain from sexual intercourse until 7 d after single-dose therapy.