Treatment of suspected nongonococcal urethritis
For the treatment of suspected nongonococcal urethritis, useOng, 2023Workowski, 2021:
1doxycycline 100 mg orally, 12-hourly for 7 days doxycycline doxycycline doxycycline
OR for patients likely to be nonadherent to doxycycline
2azithromycin 1 g orally, as a single dose. azithromycin azithromycin azithromycin
If it is not possible to distinguish nongonococcal urethritis from gonococcal urethritis, add ceftriaxone to either of the above regimensOng, 2023. Use:
ceftriaxone 500 mg intramuscularly or intravenously, as a single dose. ceftriaxone ceftriaxone ceftriaxone
Doxycycline is preferred over azithromycin for nongonococcal urethritis because it is marginally more effective for the treatment of chlamydial urethritisOng, 2023. Doxycycline and azithromycin are not sufficient to eradicate most Mycoplasma genitalium infections; however, doxycycline may reduce bacterial load and increase the likelihood of cure by subsequent therapy for M. genitalium.
Modify therapy according to the results of investigations.
If N. gonorrhoeae is identified, see Approach to Neisseria gonorrhoeae infection for additional treatment (if ceftriaxone was not used) and information on additional testing (including test of cure), contact tracing and patient advice.
If C. trachomatis is identified, finish the regimen for nongonococcal urethritis; further treatment is not required. For information on additional testing (including test of cure), contact tracing and patient advice, see Approach to Chlamydia trachomatis infection.
If M. genitalium is identified, the need for and choice of additional treatment depends on the initial treatment regimen (doxycycline or azithromycin) and confirmed or suspected macrolide resistance. Macrolide resistance is more common in gay, bisexual and other men who have sex with men, and transgender womenMachalek, 2020.
If doxycycline was used for empirical treatment of urethritis caused by M. genitalium, additional treatment is required once the doxycycline regimen has been completed.
If macrolide susceptibility is confirmed, or can be presumed (eg in heterosexual males1), follow doxycycline with:
azithromycin 1 g orally on the first day, then 500 mg daily for 3 days. azithromycin azithromycin azithromycin
If macrolide resistance is confirmed or can be presumed (eg in gay, bisexual and other men who have sex with men, and transgender women), follow doxycycline with:
moxifloxacin 400 mg orally, daily for 7 days. For dosage adjustment in adults with kidney impairment, see moxifloxacin dosage adjustment. moxifloxacin moxifloxacin moxifloxacin
If azithromycin was used for empirical treatment of urethritis caused by M. genitalium, further treatment is not required if macrolide susceptibility has been confirmed or can be presumed (eg in heterosexual males).
If azithromycin was used for empirical treatment of urethritis caused by M. genitalium, further treatment is required if macrolide resistance is confirmed or can be presumed (eg in gay, bisexual and other men who have sex with men, and transgender women). Use:
doxycycline 100 mg orally, 12-hourly for 7 days doxycycline doxycycline doxycycline
FOLLOWED BY
moxifloxacin 400 mg orally, daily for 7 days. For dosage adjustment in adults with kidney impairment, see moxifloxacin dosage adjustment. moxifloxacin moxifloxacin moxifloxacin
For information on additional testing (including test of cure), contact tracing and patient advice, see Approach to Mycoplasma genitalium infection.