Management of Urethritis

Diagnostic Approach

The Centers for Disease Control and Prevention recommends confirming urethritis through at least one of the following criteria: visible urethral discharge, positive leukocyte esterase test on first-void urine, or >10 leukocytes per high-power field in the sediment of first-void urine 1, 2, 3, 4
All patients with confirmed or suspected urethritis should be evaluated with nucleic acid amplification tests (NAAT) for N. gonorrhoeae and C. trachomatis before treatment, as recommended by the European Urology guidelines 5

Azithromycin 1 g orally in a single dose is recommended by the Centers for Disease Control and Prevention, with the main advantage being improved compliance with directly observed single-dose therapy 1, 2, 3, 4
Doxycycline 100 mg orally twice a day for 7 days is also recommended, with equal efficacy for chlamydial urethritis 1, 2, 3, 4

Ceftriaxone 1 g intramuscularly or intravenously in a single dose, plus azithromycin 1 g orally in a single dose, is recommended by the European Urology guidelines to prevent resistance and cover potential chlamydial co-infection 5

If M. genitalium is suspected or confirmed, the recommended treatment is azithromycin 500 mg orally on day 1, followed by 250 mg daily on days 2-5, as per the Praxis Medical Insights guidelines 6

The Centers for Disease Control and Prevention recommends documenting urethritis objectively with microscopy before restarting antimicrobials 1, 2, 3, 4

All patients diagnosed with a new sexually transmitted infection (STI) should be tested for other STIs, including syphilis and HIV, as recommended by the Centers for Disease Control and Prevention and the Praxis Medical Insights guidelines 1, 2, 3, 4, 6