A sexually transmitted infection (STI) is generally considered to be the underlying cause of urethritis in most, (but not all), men. Ideally, urethritis should be managed in a service specializing in sexual health, or a general practice providing an enhanced sexual health service. The following recommendations apply to men who cannot access these services within a reasonable time frame, or are unwilling to attend despite receiving appropriate advice.

• Treat empirically for chlamydial infection following local antibiotic policy. If no policy exists, prescribe:
• Doxycycline 100 mg twice a day for 7 days, or
• Azithromycin 1 gram, single dose.
• If gonococcal urethritis is suspected (for example if there is a purulent discharge), or there is a local outbreak of gonorrhoea, consider treatment for gonorrhoea after discussing this with a specialist (see the CKS topic on Gonorrhoea).
• If trichomoniasis is suspected (for example if the man's partner has trichomoniasis), see the CKS topic on Trichomoniasis.
• Provide advice, offer follow up, and ensure partner notification is undertaken for all men with urethritis.
• Assess the sexual partners of men with urethritis before offering empirical treatment.
• For at-risk sexual partners, offer empirical treatment (doxycycline 100 mg twice a day for 7 days or azithromycin 1 gram as a single dose) without waiting for microbiological diagnosis.
• For partners of men with proven chlamydial or gonorrhoeal infection, see the CKS topics on Chlamydia - uncomplicated genital and Gonorrhoea.