What antibiotics are recommended for treating penile infections?

Antibiotic Recommendations for Penile Infections

For penile infections, ceftriaxone 500 mg IM as a single dose is the recommended first-line treatment, with additional antibiotics based on the specific pathogen identified. 1

Treatment Based on Specific Pathogens

Gonococcal Infections (N. gonorrhoeae)

• First-line treatment: Ceftriaxone 1 g IM or IV as a single dose 1
• Alternative regimens:
  • Cefixime 400 mg PO as a single dose plus azithromycin 1 g PO as a single dose 1
  • For cephalosporin allergy: Gentamicin 240 mg IM as a single dose plus azithromycin 2 g PO as a single dose 1
  • Spectinomycin 2 g IM as a single dose (useful for patients who cannot tolerate cephalosporins and quinolones) 1

Non-gonococcal Urethritis

• First-line treatment:
  • Azithromycin 1 g PO as a single dose 1
  • Doxycycline 100 mg PO twice daily for 7 days 1, 2
• Alternative regimens:
  • Erythromycin base 500 mg PO four times daily for 3 weeks 1, 3
  • Levofloxacin 500 mg PO daily for 7 days 1

Chlamydial Infections (C. trachomatis)

• First-line treatment:
  • Azithromycin 1-1.5 g PO as a single dose 1
  • Doxycycline 100 mg PO twice daily for 7 days 1
• Alternative regimens:
  • Levofloxacin 500 mg PO daily for 7 days 1
  • Ofloxacin 200 mg PO twice daily for 7 days 1

Mycoplasma genitalium

• First-line treatment: Azithromycin 500 mg PO on day 1 1
• For macrolide resistance: Moxifloxacin 400 mg daily for 7-14 days 1

Ureaplasma urealyticum

• First-line treatment: Doxycycline 100 mg PO twice daily for 7 days 1
• Alternative regimen: Azithromycin 1-1.5 g PO as a single dose 1

Trichomonas vaginalis

• First-line treatment: Metronidazole/Tinidazole 2 g PO as a single dose 1
• Alternative regimen: Metronidazole 500 mg PO twice daily for 7 days 1

Persistent or Recurrent Urethritis

• After first-line doxycycline:

  • Azithromycin 500 mg PO on day 1, then 250 mg PO for 4 days 1
  • If macrolide-resistant M. genitalium is detected, use moxifloxacin instead 1

• After first-line azithromycin:

  • Moxifloxacin 400 mg PO daily for 7-14 days 1
  • Metronidazole 400 mg PO twice daily for 5 days 1

Special Considerations

Dual Therapy for Gonococcal and Chlamydial Infections

• When chlamydial infection cannot be ruled out, add:
  • Azithromycin 1 g PO as a single dose, OR
  • Doxycycline 100 mg PO twice daily for 7 days 1

Pregnancy

• Pregnant women should not be treated with quinolones or tetracyclines 1
• For N. gonorrhoeae infection in pregnancy: Use recommended cephalosporin regimens 1
• For patients who cannot tolerate cephalosporins: Spectinomycin 2 g IM as a single dose 1

Allergy Considerations

• For patients allergic to cephalosporins or quinolones: Spectinomycin is recommended 1
• Note that spectinomycin is less effective (52%) against pharyngeal infections 1

Follow-Up Recommendations

• Patients treated with recommended regimens for uncomplicated gonorrhea generally do not need test-of-cure 1
• Patients with persistent symptoms should be evaluated by culture for N. gonorrhoeae, with antimicrobial susceptibility testing 1
• Patients should abstain from sexual intercourse until therapy is completed and until they and their partners no longer have symptoms 1

Partner Management

• All sexual partners of patients with N. gonorrhoeae infection should be evaluated and treated if their last sexual contact was within 60 days before onset of symptoms or diagnosis 1
• If a patient's last sexual intercourse was more than 60 days before symptoms or diagnosis, the most recent sex partner should be treated 1

Common Pitfalls to Avoid

• Fluoroquinolones (ciprofloxacin, levofloxacin) should be used with caution due to increasing resistance 1, 4
• Azithromycin 2 g PO can be effective against uncomplicated gonococcal infection but causes significant gastrointestinal distress and is expensive 1, 5
• Azithromycin 1 g PO alone is insufficient for gonorrhea treatment 1, 6
• Single-agent therapy may miss co-infections; consider dual therapy when appropriate 7
• Oral penicillin is not effective for treating gonococcal infections 1