Urethritis Empiric Therapy

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.