Urethritis Medication

Updated: Dec 18, 2020
  • Author: Dustin L Whitaker, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Medication Summary

Administer antibiotics to patients who meet diagnostic criteria for infectious urethritis. Treat all sexual partners of those patients, regardless of symptoms. In patients with a negative Gram stain but history concerning for urethritis, treat empirically if they are at high risk for being noncompliant with follow-up and/or are likely to continue transmitting infection (eg, commercial sex worker, intravenous drug user, homeless person). The latter group may best be served with single-dose therapies.



Class Summary

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting. [21]

The antimicrobial options in the treatment of gonococcal urethritis (GU) include IM ceftriaxone, oral cefixime, oral azithromycin, oral gemifloxacin, and IM gentamicin. Chlamydia trachomatis is the most common cause of nongonococcal urethritis (NGU), and azithromycin and doxycycline have been proven equally efficacious in treatment, although azithromycin is superior to doxycycline in treating Mycoplasma genitalium, the second most common cause of NGU.

Alternative regimens for treating NGU include erythromycin, levofloxacin, and ofloxacin. Moxifloxacin may be used to treat persistent or recurrent NGU. Combinations of probenecid with penicillin, amoxicillin, or ampicillin are no longer used because of resistance. 

Patients with proven GU should be empirically treated for C trachomatis infection. Empiric treatment is less expensive than culture in any population whose coinfection rate is at least 10%. Single-dose empiric treatments offer an advantage in patients who are noncompliant or unlikely to return for follow-up. Single-dose regimens include azithromycin for C trachomatis and ceftriaxone, cefixime, gemifloxacin, or gentamicin for Neisseria gonorrhea.

A single dose of metronidazole plus a 7-day course of erythromycin is recommended for NGU recurrence. Antibiotic therapy is recommended for affected individuals and sexual partners of individuals with documented trichomonal infection, even if asymptomatic.