What is the recommended treatment for a sexually active man with a urinary tract infection (UTI) who is concerned about sexually transmitted diseases (STDs)?

From the Guidelines

For a sexually active man with a urinary tract infection who is concerned about STDs, the recommended treatment involves addressing both conditions with empiric antibiotics for the UTI and STD testing, followed by targeted treatment based on test results, as suggested by guidelines from 1. The patient should initially receive empiric treatment with antibiotics such as trimethoprim-sulfamethoxazole (Bactrim DS) 160/800 mg twice daily for 7 days or nitrofurantoin (Macrobid) 100 mg twice daily for 5-7 days for the UTI.

• It is crucial to perform STD testing since UTI symptoms can overlap with those of STDs like chlamydia, gonorrhea, or trichomoniasis.
• While awaiting results, empiric treatment for common STDs may include a single 1g dose of azithromycin for chlamydia and a single 250mg intramuscular injection of ceftriaxone for gonorrhea, as per the guidelines from 1.
• The patient should abstain from sexual activity or use condoms consistently until treatment is complete and symptoms resolve.
• Ensuring adequate hydration by drinking plenty of water and completing the full course of antibiotics even if symptoms improve quickly is essential. This comprehensive approach addresses both the UTI and potential STDs, as untreated infections can lead to complications such as epididymitis, prostatitis, or urethral strictures, highlighting the importance of regular STD screening for sexually active individuals, especially those with multiple partners or inconsistent condom use, as noted in 1 and 1.

From the FDA Drug Label

Uncomplicated gonococcal infections in adults (except anorectal infections in men):100 mg, by mouth, twice a day for 7 days. Uncomplicated urethral, endocervical, or rectal infection in adults caused by Chlamydia trachomatis: 100 mg, by mouth, twice a day for 7 days. Nongonococcal urethritis (NGU) caused by C. trachomatis or U. urealyticum: 100 mg, by mouth, twice a day for 7 days.

The recommended treatment for a sexually active man with a urinary tract infection (UTI) who is concerned about sexually transmitted diseases (STDs) is doxycycline 100 mg, by mouth, twice a day for 7 days 2.

• Key points:
  • Doxycycline is effective against common STDs such as gonorrhea and chlamydia.
  • The recommended dose is 100 mg, by mouth, twice a day for 7 days.
  • It is essential to note that doxycycline may not be effective against all types of bacteria that cause UTIs, and further testing may be necessary to determine the causative organism.
• Important consideration: Patients with suspected STDs should undergo serologic testing for syphilis and appropriate cultures for gonorrhea, and antimicrobial therapy should be adjusted accordingly.

From the Research

Treatment Recommendations for Sexually Active Men with UTI Concerned about STDs

• The Centers for Disease Control and Prevention (CDC) recommends a single 500 mg intramuscular dose of ceftriaxone for the treatment of uncomplicated urogenital, anorectal, and pharyngeal gonorrhea 3, 4.
• If chlamydial infection has not been excluded, concurrent treatment with doxycycline (100 mg orally twice a day for 7 days) is recommended 3, 5.
• Ceftriaxone is the preferred treatment due to its efficacy and the increasing resistance of Neisseria gonorrhoeae to azithromycin 3, 5.
• Alternative treatments are limited, and there are no recommended alternative therapies for N gonorrhoeae infection of the throat 5.

Antibiotic Resistance and Treatment Efficacy

• Neisseria gonorrhoeae has developed resistance to all first-line recommended therapies, making gonococcal antimicrobial resistance a major public health concern 5.
• The use of ceftriaxone has been shown to be effective in treating gonorrhea, with minimal inhibitory concentrations (MICs) remaining stable in the United States 5.
• A new oral treatment option, gepotidacin, has been shown to be non-inferior to ceftriaxone plus azithromycin for the treatment of uncomplicated urogenital gonorrhea 6.

Diagnosis and Treatment of Sexually Transmitted Infections

• Sexually transmitted infections (STIs) are a significant public health concern, with approximately 1 in 5 adults in the US having an STI in 2018 7.
• The diagnosis and treatment of STIs, including gonorrhea, chlamydia, and syphilis, are crucial in preventing complications and transmission 7.
• Nucleic acid amplification tests have high sensitivities and specificities for the diagnosis of gonorrhea, chlamydia, and other STIs 7.