What is the appropriate treatment for a patient with a 4-day history of sore throat and symptoms of dysuria, including burning and itching sensations during urination?

Treatment for Sore Throat with Dysuria

This patient requires empirical treatment for both pharyngitis and urethritis, with doxycycline 100 mg orally twice daily for 7 days as the primary regimen to cover nongonococcal urethritis, plus symptomatic management for the sore throat. 1

Clinical Reasoning

The combination of sore throat and dysuria with burning/itching suggests two concurrent processes that require separate consideration:

Urethritis Management

The burning and itching during urination indicates urethritis, which must be treated empirically when diagnostic tools are unavailable. 1

• The two primary bacterial agents responsible for urethritis are N. gonorrhoeae and C. trachomatis 1
• C. trachomatis is the most frequent cause of nongonococcal urethritis (23%-55% of cases), with Ureaplasma urealyticum causing 20%-40% and Trichomonas vaginalis 2%-5% 1
• Urethritis can be sexually transmitted and requires differentiation between gonococcal and nongonococcal causes 1

Recommended treatment regimen:

• Doxycycline 100 mg orally twice daily for 7 days 1

Alternative regimens if doxycycline cannot be used:

• Erythromycin base 500 mg orally 4 times daily for 7 days 1
• Erythromycin ethylsuccinate 800 mg orally 4 times daily for 7 days 1
• For patients intolerant to high-dose erythromycin: Erythromycin base 250 mg orally 4 times daily for 14 days 1

Pharyngitis Management

The 4-day history of sore throat likely represents viral or bacterial pharyngitis requiring symptomatic treatment unless streptococcal infection is suspected or confirmed.

• If Streptococcus pyogenes is suspected or confirmed, at least 10 days of treatment is required to prevent acute rheumatic fever 2
• Amoxicillin dosing for pharyngitis in adults: 500 mg every 12 hours or 250 mg every 8 hours for mild/moderate infections 2

Critical Follow-Up Instructions

Patients must be instructed to return if symptoms persist or recur after completing therapy. 1

• If symptoms persist despite treatment compliance, consider re-treatment with an alternative 14-day regimen (erythromycin base 500 mg orally 4 times daily for 14 days) to cover possible tetracycline-resistant U. urealyticum 1
• Perform wet mount examination and culture for T. vaginalis if initial treatment fails 1

Partner Management

Sex partners must be evaluated and treated. 1

• Partners whose last sexual contact with the patient was within 30 days of symptom onset should be evaluated and treated 1
• Patients must abstain from sexual intercourse until both patient and partners complete therapy and are without symptoms 1

Common Pitfalls to Avoid

• Do not delay treatment waiting for diagnostic confirmation when testing is unavailable 1
• Do not treat only one condition—both the urethritis and pharyngitis require attention 1
• Do not use fluoroquinolones empirically if the patient has used them in the last 6 months or has high local resistance rates (>10%) 1
• Do not forget to address partner notification and treatment, as this prevents reinfection and further transmission 1