• Treatment should be initiated as soon as possible after diagnosis
• Single-dose regimens have the advantage of improved compliance and of DOT
• To improve compliance, the medication should be provided in the clinic or health-care provider's office.

Recommended Regimens

Azithromycin 1 g orally in a single dose,
OR
Doxycycline 100 mg orally twice a day for 7 days.

Alternative Regimens

Erythromycin base 500 mg orally four times a day for 7 days,
OR
Erythromycin ethylsuccinate 800 mg orally four times a day for 7 days,
OR
Ofloxacin 300 mg twice a day for 7 days,
OR
Levofloxacin 500 mg once daily for 7 days.

Follow-Up for Patients Who Have Urethritis

• Patients should be instructed to return for evaluation if symptoms persist or recur after completion of therapy
• Symptoms alone, without documentation of signs or laboratory evidence of urethral inflammation, are not a sufficient basis for re-treatment
• Patients should be instructed to abstain from sexual intercourse until 7 days after therapy is initiated

Recurrent and Persistent Urethritis

• Objective signs of urethritis should be present before initiation of antimicrobial therapy
• Effective regimens have not been identified for treating patients who do not have objective signs of urethritis but who have persistent symptoms after treatment
• Patients who have persistent or recurrent urethritis should be re-treated with the initial regimen if they did not comply with the treatment regimen or if they were reexposed to an untreated sex partner. Otherwise, a culture of an intra-urethral swab specimen and a first-void urine specimen for T. vaginalis should be performed
• Some cases of recurrent urethritis following doxycycline treatment may be caused by tetracycline-resistant U. urealyticum
• Urologic examinations usually do not reveal a specific etiology. If the patient was compliant with the initial regimen and re-exposure can be excluded, the following regimen is recommended.

Recommended Regimens
Metronidazole 2 g orally in a single dose
PLUS
Erythromycin base 500 mg orally four times a day for 7 days
OR
Erythromycin ethylsuccinate 800 mg orally four times a day for 7 days.

References

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