Antibiotic Recommendations for Penile Infections

Treatment Based on Specific Pathogens

The European Urology Association recommends ceftriaxone 500 mg IM as a single dose as the first-line treatment for penile infections, with additional antibiotics based on the specific pathogen identified 1
For gonococcal infections, the European Urology Association recommends ceftriaxone 1 g IM or IV as a single dose as the first-line treatment 1
For non-gonococcal urethritis, the Journal of Microbiology, Immunology and Infection recommends azithromycin 1 g PO as a single dose or doxycycline 100 mg PO twice daily for 7 days as the first-line treatment 3, 4
For chlamydial infections, the European Urology Association recommends azithromycin 1-1.5 g PO as a single dose or doxycycline 100 mg PO twice daily for 7 days as the first-line treatment 1
For Mycoplasma genitalium, the European Urology Association recommends azithromycin 500 mg PO on day 1 as the first-line treatment, and moxifloxacin 400 mg daily for 7-14 days for macrolide-resistant cases 1
For Ureaplasma urealyticum, the European Urology Association recommends doxycycline 100 mg PO twice daily for 7 days as the first-line treatment, and azithromycin 1-1.5 g PO as a single dose as an alternative regimen 1
For Trichomonas vaginalis, the European Urology Association recommends metronidazole/tinidazole 2 g PO as a single dose as the first-line treatment, and metronidazole 500 mg PO twice daily for 7 days as an alternative regimen 1

The MMWR Recommendations and Reports suggest that pregnant women should not be treated with quinolones or tetracyclines, and recommend using cephalosporin regimens for N. gonorrhoeae infection in pregnancy 5
The MMWR Recommendations and Reports recommend spectinomycin 2 g IM as a single dose for patients who cannot tolerate cephalosporins, but note that it is less effective against pharyngeal infections 5

The MMWR Recommendations and Reports state that patients treated with recommended regimens for uncomplicated gonorrhea generally do not need test-of-cure, but patients with persistent symptoms should be evaluated by culture for N. gonorrhoeae with antimicrobial susceptibility testing 5, 2
The MMWR Recommendations and Reports recommend that patients abstain from sexual intercourse until therapy is completed and until they and their partners no longer have symptoms 5

The MMWR Recommendations and Reports recommend that 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 5, 2

The Journal of Microbiology, Immunology and Infection notes that fluoroquinolones should be used with caution due to increasing resistance 3, 4
The MMWR Recommendations and Reports state that azithromycin 2 g PO can be effective against uncomplicated gonococcal infection but causes significant gastrointestinal distress and is expensive 5
The MMWR Recommendations and Reports note that azithromycin 1 g PO alone is insufficient for gonorrhea treatment 5
The Journal of Microbiology, Immunology and Infection states that oral penicillin is not effective for treating gonococcal infections 3, 4