Urethritis Organism-Specific Therapy 

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Organism-specific therapeutic regimens for urethritis are provided below, including those for the following [1, 2, 3, 4, 5, 6] :

Neisseria gonorrhoeae (gonococcal urethritis):

Ceftriaxone 250 mg IM in a single dose (strongly preferred) plus

Azithromycin 1 g PO in a single dose or

Doxycycline 100 mg PO BID for 7 days (if allergic to azithromycin)

If ceftriaxone is not available:

Cefixime 400 mg PO in a single dose plus

Azithromycin 1 g PO in a single dose or

Doxycycline 100 mg PO BID for 7 days  (if allergic to azithromycin)

If patient has a severe cephalosporin allergy:

Azithromycin 2 g PO in a single dose plus

Gemifloxacin 320 mg PO in a single dose or

Gentamicin 240 mg IM in a single dose

Chlamydia trachomatis:

Azithromycin 1 g PO in a single dose or

Doxycycline 100 mg PO BID for 7d or

Erythromycin base 500 mg PO QID for 7d or

Erythromycin ethylsuccinate 800 mg PO QID for 7d or

Ofloxacin 300 mg PO BID for 7d or

Levofloxacin 500 mg PO once daily for 7d

Ureaplasma urealyticum:

Doxycycline 100 mg PO BID for 7d

Mycoplasma hominis:

Azithromycin 1 g PO in a single dose or

Doxycycline 100 mg PO BID for 7d or

Erythromycin base 500 mg PO QID for 7d or

Erythromycin ethylsuccinate 800 mg PO QID for 7d

Mycoplasma genitalium

Azithromycin 1 g PO in a single dose

Workowski KA, Bolan GA. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015 Jun 5. 64:51-68.

Centers for Disease Control and Prevention. Update to CDC’s sexually transmitted diseases treatment guidelines, 2006: fluoroquinolones no longer recommended for treatment of gonococcal infections. MMWR Morb Mortal Wkly Rep. 2007 Apr 13. 56(14):332-6. [Medline].

Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep. 2010 Dec 17. 59 (RR-12):1-110.

Terris MK, Sajadi KP. Urethritis. Medscape Reference. Updated August 10, 2009. Available at http://emedicine.medscape.com/article/438091-overview.

Workowski KA, Bolan GA, Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015 Jun 5. 64 (RR-03):1-137. [Medline].

Lau A, Bradshaw CS, Lewis D, Fairley CK, Chen MY, Kong FY, et al. The Efficacy of Azithromycin for the Treatment of Genital Mycoplasma genitalium: A Systematic Review and Meta-analysis. Clin Infect Dis. 2015 Nov 1. 61 (9):1389-99. [Medline].

CDC. Update to CDC’s Sexually transmitted diseases treatment guidelines, 2010: oral cephalosporins no longer a recommended treatment for gonococcal infections. MMWR Morb Mortal Wkly Rep. 2012 Aug 10. 61(31):590-4. [Medline].

Thomas E Herchline, MD Professor of Medicine, Wright State University, Boonshoft School of Medicine; Medical Consultant, Public Health, Dayton and Montgomery County (Ohio) Tuberculosis Clinic

Thomas E Herchline, MD is a member of the following medical societies: Alpha Omega Alpha, Infectious Diseases Society of America, Infectious Diseases Society of Ohio

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America; Fellow of the Royal College of Physicians, London

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Urethritis Organism-Specific Therapy 

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