From the Guidelines
The recommended antibiotics for the treatment of urethritis are ceftriaxone 1g intramuscularly or intravenously as a single dose for gonococcal infection, and doxycycline 100mg twice daily for 7 days for non-gonococcal infection. According to the European Association of Urology guidelines on urological infections, published in 2024 1, the treatment of urethritis depends on the causative pathogen. For gonococcal infection, ceftriaxone is the preferred treatment, with alternative regimens including cefixime 400mg orally as a single dose plus azithromycin 1g orally as a single dose 1. For non-gonococcal infection, doxycycline 100mg twice daily for 7 days is the recommended treatment, with azithromycin 500mg orally on day 1, followed by 250mg orally for 4 days as an alternative regimen 1. It is essential to note that the treatment of urethritis should be guided by the identification of the causative pathogen, and that sexual partners should also be treated to prevent reinfection. The choice of antibiotic should also take into account the potential for antibiotic resistance, and patients should be tested for other sexually transmitted infections since they commonly occur together. In cases where symptoms persist after treatment, follow-up evaluation is necessary to determine the cause of treatment failure, which may be due to antibiotic resistance or reinfection 1. Key points to consider when treating urethritis include:
- Completing the full course of antibiotics even if symptoms improve before finishing treatment
- Treating sexual partners to prevent reinfection
- Abstaining from sexual activity until both the patient and their partners complete treatment
- Testing for other sexually transmitted infections
- Follow-up evaluation if symptoms persist after treatment 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 antibiotics for the treatment of urethritis are:
- Doxycycline: 100 mg, by mouth, twice a day for 7 days 2
- Azithromycin: (dosage not specified in the label for urethritis, but it is indicated for the treatment of urethritis and cervicitis due to Chlamydia trachomatis or Neisseria gonorrhoeae) 3
From the Research
Treatment Options for Urethritis
The recommended antibiotics for the treatment of urethritis include:
- Doxycycline 100 mg twice a day for one week 4, 5, 6, 7
- Azithromycin 1 gram single dose or 1.5 gram distributed in five days 4, 8, 6, 7
- Moxifloxacin 400 mg for 7-14 days for macrolide-resistant strains of Mycoplasma genitalium 4
- Ceftriaxone 250mg intramuscularly for Neisseria gonorrhoeae 5
- Cefixime as an alternative to ceftriaxone 7
Considerations for Treatment
- The choice of antibiotic should be based on the suspected cause of the urethritis, with azithromycin and doxycycline being effective against Chlamydia trachomatis and Ureaplasma urealyticum 8, 6
- A test of cure should be performed three weeks after the start of treatment for Mycoplasma genitalium 4
- Patients with persistent or recurrent symptoms should be re-evaluated and retreated with antimicrobial agents if necessary 4, 5
- Current partners should be tested and treated with the same regimen, and both patients and partners should abstain from intercourse until treatment is completed 4, 7