Treatment of Urethritis in Men

Diagnosis and Etiology

The Centers for Disease Control and Prevention recommends that urethritis should be confirmed by at least one of the following: mucopurulent or purulent urethral discharge, positive leukocyte esterase test on first-void urine, or ≥10 WBC per high-power field on microscopic examination of first-void urine sediment 1
All patients with suspected urethritis should be tested for both Neisseria gonorrhoeae and Chlamydia trachomatis, as recommended by the Centers for Disease Control and Prevention 1, 2
Chlamydia trachomatis is the most common cause of non-gonococcal urethritis (NGU), accounting for 15-55% of cases, according to the Centers for Disease Control and Prevention 3

The American College of Physicians recommends azithromycin 1g orally in a single dose as a first-line treatment option for urethritis in men, which is particularly effective against Mycoplasma genitalium 1
The Centers for Disease Control and Prevention recommends doxycycline 100mg orally twice daily for 7 days as a first-line treatment option for urethritis in men, which is highly effective for chlamydial urethritis 1, 2

The Centers for Disease Control and Prevention recommends that all sex partners within the preceding 60 days should be referred for evaluation and treatment, and partners should receive treatment effective against chlamydia regardless of whether a specific etiology is identified in the index patient 1, 2
Patients and partners should abstain from sexual intercourse until 7 days after therapy is initiated and symptoms have resolved, as recommended by the Centers for Disease Control and Prevention 2

The American College of Physicians recommends confirming objective signs of urethritis before initiating further antimicrobial therapy, and ruling out non-compliance with initial treatment or re-exposure to untreated partner 1
The Centers for Disease Control and Prevention recommends metronidazole 2g orally in a single dose or tinidazole 2g orally in a single dose, PLUS azithromycin 1g orally in a single dose (if not used for initial episode) for persistent or recurrent urethritis 1

The Centers for Disease Control and Prevention recommends that patients should return for evaluation if symptoms persist or recur after treatment completion, and test-of-cure is not recommended for asymptomatic patients who received recommended treatment 1, 2
The American College of Physicians recommends considering repeat testing 3-6 months after treatment due to high rate of reinfection 1

The Centers for Disease Control and Prevention recommends empiric treatment without documentation of urethritis only for high-risk patients unlikely to return for follow-up, and patients diagnosed with a new STD should receive testing for other STDs, including syphilis and HIV 1, 2, 3