From the Guidelines
The recommended antibiotic regimen for urethritis is ceftriaxone 1g intramuscularly or intravenously as a single dose for gonococcal infection, and doxycycline 100mg twice daily for 7 days for non-gonococcal infection. The choice of antibiotic depends on the causative pathogen, with gonococcal urethritis typically treated with ceftriaxone, and non-gonococcal urethritis treated with doxycycline or azithromycin 1.
Key Considerations
- For gonococcal urethritis, alternative regimens include cefixime 400mg orally as a single dose plus azithromycin 1g orally as a single dose, or gentamicin 240mg intramuscularly as a single dose plus azithromycin 2g orally as a single dose 1.
- For non-gonococcal urethritis, azithromycin 1g orally as a single dose is an alternative regimen, but resistance is increasing 1.
- Patients with confirmed gonorrhea should also receive treatment for chlamydia, as co-infection is common 1.
- Patients should abstain from sexual activity for 7 days after treatment completion and until symptoms resolve, and partners from the previous 60 days should be notified and treated 1.
Treatment Options
- Doxycycline 100mg twice daily for 7 days is the preferred treatment for non-gonococcal urethritis, with azithromycin 1g orally as a single dose as an alternative 1.
- For persistent non-gonococcal urethritis, moxifloxacin 400mg orally once daily for 7-14 days or metronidazole 400mg twice daily for 5 days can be used as alternative regimens 1.
Important Notes
- The treatment regimens should be chosen based on the most recent and highest quality evidence, with consideration of local resistance patterns and patient factors 1.
- Follow-up testing is recommended if symptoms persist, and patients should be instructed to return for evaluation if symptoms persist or recur after completion of therapy 1.
From the FDA Drug Label
Urethritis and cervicitis due to Chlamydia trachomatis or Neisseria gonorrhoeae. Non-gonoccocal urethritis and cervicitisOne single 1 gram dose Gonococcal urethritis and cervicitisOne single 2 gram dose
The recommended antibiotic regimen for urethritis is azithromycin. The dosage is:
- 1 gram as a single dose for non-gonococcal urethritis and cervicitis
- 2 grams as a single dose for gonococcal urethritis and cervicitis 2
From the Research
Antibiotic Regimen for Urethritis
The recommended antibiotic regimen for urethritis depends on the cause of the infection. According to 3, the most important causes of urethritis are Chlamydia trachomatis and Neisseria gonorrhoeae.
- For Neisseria gonorrhoeae, a single-dose regimen active against N. gonorrhoeae, plus a regimen active against C. trachomatis and nongonococcal urethritis is recommended 3.
- The usually recommended treatment for N. gonorrhoeae is a single dose of ceftriaxone 250mg intramuscularly, but there are many alternatives, including oral ones 3.
- For Chlamydia trachomatis or nongonococcal urethritis, 7 days' treatment with a tetracycline is recommended 3.
- Some guidelines now propose ofloxacin 300 mg orally twice daily for 7 days as an equivalent alternative, and there are very promising data with a single dose therapy with azithromycin, a long-acting macrolide antimicrobial 3.
Update to CDC's Treatment Guidelines
As of 2020, the CDC recommends a single 500 mg IM dose of ceftriaxone for treatment of uncomplicated urogenital, anorectal, and pharyngeal gonorrhea 4.
- If chlamydial infection has not been excluded, concurrent treatment with doxycycline (100 mg orally twice a day for 7 days) is recommended 4.
Clinical Efficacy of Azithromycin
A single oral 2 g dose of azithromycin extended-release has been shown to be effective for heterosexual male patients with urethritis, with an eradication rate of 90.9% for gonococcal urethritis and 90.0% for nongonococcal urethritis 5.
- The microbiological eradication rates for the pathogens were 90.9% for Neisseria gonorrhoeae, 91.5% for Chlamydia trachomatis, 71.4% for Mycoplasma genitalium, and 100% for Ureaplasma urealyticum 5.
Azithromycin vs Doxycycline
Azithromycin has been compared to doxycycline in the treatment of non-gonococcal urethritis, with satisfactory clearance of C. trachomatis from post-treatment cultures for all regimens 6.
- A single dose of azithromycin has been shown to be as effective as a standard 7-day course of doxycycline in achieving clinical cure for empirical treatment of the acute nongonococcal urethritis syndrome in men 7.