Empiric Therapy Regimens

Empiric therapeutic regimens for urethritis are outlined below, including those for the following^{[2, 4, 5, 6]}:

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:

Azithromycin 1 g PO in a single dose or doxycycline 100 mg PO BID for 7d (contraindicated during pregnancy) plus
Ceftriaxone 250 mg IM in a single dose (strongly preferred) or cefixime 400 mg PO in a single dose (plus test-of-cure in 1 week)
Fluoroquinolones should not be used as empiric therapy because of increasing resistance of Neisseria gonorrhoeae isolates.

Nongonococcal urethritis

First-line regimens:

Azithromycin 1 g PO in a single dose or
Doxycycline 100 mg PO BID for 7d (contraindicated during pregnancy)

Alternative regimens:

Erythromycin base 500 mg PO QID for 7d or
Erythromycin ethylsuccinate 800 mg PO QID for 7d or
Ofloxacin 300 mg PO BID for 7d or
Levofloxacin 500 mg PO once daily for 7d

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 Neisseria gonorrhoeae should be instructed to abstain from sexual intercourse until 7 d after single-dose therapy