From the Guidelines
The recommended outpatient treatment for urethritis is typically a single 1-gram dose of ceftriaxone intramuscularly or intravenously, plus azithromycin 1 gram orally as a single dose for gonococcal infection, or doxycycline 100 mg orally twice daily for 7 days for non-gonococcal infection. The choice of antibiotic regimen depends on the suspected or confirmed causative pathogen, with gonococcal infection treated with ceftriaxone and azithromycin, and non-gonococcal infection treated with doxycycline or azithromycin 1. Some key points to consider in the treatment of urethritis include:
- For gonococcal infection, alternative regimens include cefixime 400 mg orally plus azithromycin 1 gram orally as single doses, or gentamicin 240 mg intramuscularly plus azithromycin 2 grams orally as single doses 1.
- For non-gonococcal infection, alternative regimens include azithromycin 500 mg orally on day 1, then 250 mg orally for 4 days 1.
- Patients with suspected or confirmed chlamydial urethritis should be treated with azithromycin 1.0-1.5 grams orally as a single dose, or doxycycline 100 mg orally twice daily for 7 days 1.
- Patients should abstain from sexual activity for 7 days after treatment initiation and until all symptoms have resolved, and partners from the previous 60 days should be notified, tested, and treated empirically even if asymptomatic. Follow-up testing is recommended if symptoms persist, to ensure resolution of the infection and to prevent long-term complications such as infertility or chronic pain 1.
From the FDA Drug Label
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. Urethritis and cervicitis due to Chlamydia trachomatis or Neisseria gonorrhoeae.
The recommended outpatient treatment for urethritis is doxycycline 100 mg orally twice a day for 7 days 2 or azithromycin as an alternative treatment option 3.
- Doxycycline is recommended for the treatment of uncomplicated urethral, endocervical, or rectal infections caused by Chlamydia trachomatis and for nongonococcal urethritis (NGU) caused by C. trachomatis or U. urealyticum.
- Azithromycin is also an option for the treatment of urethritis and cervicitis due to Chlamydia trachomatis or Neisseria gonorrhoeae.
From the Research
Urethritis Outpatient Treatment
The recommended outpatient treatment for urethritis depends on the cause of the infection. The most common causes of urethritis are Chlamydia trachomatis and Neisseria gonorrhoeae.
Treatment Options
- For Neisseria gonorrhoeae, the recommended treatment is a single dose of ceftriaxone 250mg intramuscularly, plus a regimen active against C. trachomatis and nongonococcal urethritis 4.
- For Chlamydia trachomatis or nongonococcal urethritis, the recommended treatment is 7 days of a tetracycline, or a single dose of azithromycin 1g orally 4, 5, 6.
- Azithromycin has been shown to be as effective as doxycycline in treating nongonococcal urethritis, with the advantage of a single dose regimen 5, 6.
- The Centers for Disease Control and Prevention (CDC) recommends a single 500mg IM dose of ceftriaxone for treatment of uncomplicated urogenital, anorectal, and pharyngeal gonorrhea, with concurrent treatment with doxycycline if chlamydial infection has not been excluded 7.
Patient Preference and Compliance
- Single dose therapy with azithromycin has been shown to have advantages in patient follow-up rates and contact attendance, and is the preferred treatment option for the majority of patients 8.
- A cost analysis supports the practical application of single dose therapy with azithromycin 8.
Important Considerations
- Optimal management of urethritis requires obtaining a thorough sexual history, evaluation for objective clinical and laboratory evidence of infection, antimicrobial therapy directed towards the major aetiologies, and evaluation and treatment of sexual partners 4.
- Recurrent urethritis is frequent, and patients with persistent or recurrent symptoms require careful re-evaluation and retreatment with antimicrobial agents if necessary 4.