From the Guidelines
The most effective treatment for urethritis in males is typically antibiotics targeting the most common causative organisms, with doxycycline 100mg twice daily for 7 days being the first-line treatment for non-gonococcal urethritis (NGU) and ceftriaxone 1g as a single intramuscular injection plus azithromycin 1g orally for gonococcal urethritis, as recommended by the European Association of Urology guidelines in 2024 1.
Treatment Options
- For non-gonococcal urethritis (NGU), doxycycline 100mg twice daily for 7 days is the first-line treatment, as it effectively treats Chlamydia trachomatis and Mycoplasma genitalium.
- Alternatively, azithromycin 1g as a single dose can be used, though resistance is increasing.
- For gonococcal urethritis, ceftriaxone 1g as a single intramuscular injection plus azithromycin 1g orally is recommended due to increasing antibiotic resistance patterns.
Additional Considerations
- During treatment, patients should abstain from sexual activity for at least 7 days and until symptoms resolve to prevent transmission.
- Partners from the previous 60 days should be notified and treated to prevent reinfection.
- Patients should also be tested for other sexually transmitted infections including HIV, syphilis, and hepatitis B.
- If symptoms persist after treatment, follow-up evaluation is necessary to rule out resistant organisms or reinfection, as suggested by the Centers for Disease Control and Prevention in 2002 1.
Antibiotic Mechanism
- These antibiotics work by disrupting bacterial protein synthesis or cell wall formation, effectively eliminating the infection and resolving symptoms like discharge, burning during urination, and urethral discomfort.
From the FDA Drug Label
Urethritis and cervicitis due to Chlamydia trachomatis or Neisseria gonorrhoeae. All patients with sexually-transmitted urethritis or cervicitis should have a serologic test for syphilis and appropriate cultures for gonorrhea performed at the time of diagnosis. Appropriate antimicrobial therapy and follow-up tests for these diseases should be initiated if infection is confirmed To reduce the development of drug-resistant bacteria and maintain the effectiveness of azithromycin and other antibacterial drugs, azithromycin should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria
The recommended treatment for urethritis in males is azithromycin, which is effective against Chlamydia trachomatis or Neisseria gonorrhoeae.
- Key points:
- Patients should have a serologic test for syphilis and cultures for gonorrhea at diagnosis.
- Antimicrobial therapy should be initiated if infection is confirmed.
- Azithromycin should only be used to treat infections proven or strongly suspected to be caused by susceptible bacteria 2
From the Research
Treatment Options for Urethritis in Males
- The recommended treatment for urethritis in males includes antibiotics such as doxycycline and azithromycin 3, 4, 5, 6, 7.
- Doxycycline can be given at a dose of 100 mg twice a day for one week, while azithromycin can be given as a single dose of 1 gram or 1.5 grams distributed over five days 3, 4, 5, 6.
- Azithromycin has been shown to be effective in treating chlamydial urethritis, with a single dose being as effective as a seven-day course of doxycycline 4, 5, 6.
- For Mycoplasma genitalium-positive urethritis, a single dose of azithromycin has been shown to be more effective than a seven-day course of doxycycline 7.
Diagnosis and Testing
- The diagnosis of urethritis is confirmed by demonstrating an excess of polymorphonuclear leucocytes (PMNLs) in a stained smear 3.
- Nucleic acid amplification tests (NAAT) can be used to test for Neisseria gonorrhoeae, Chlamydia trachomatis, and Mycoplasma genitalium 3.
- If viral or protozoan etiology is suspected, NAAT for HSV, adenovirus, and Trichomonas vaginalis can be used, if available 3.
Treatment of Partners
- Current partners of men with urethritis should be tested and treated with the same regimen 3.
- Partners should abstain from intercourse until both have completed treatment 3.