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Urethritis - male - Management
Basis for recommendation

These recommendations are based on expert opinion from a UK National Guideline on the Management of non-gonococcal urethritis (NGU), published by the British Association for Sexual Health and HIV (BASHH) [BASHH, 2007], and a primary care guideline published by BASHH and the Royal College of General Practitioners [RCGP and BASHH, 2006].

Empirical treatment

  • Treating urethritis promptly not only alleviates symptoms but reduces ongoing transmission and halts the spread of infection [RCGP and BASHH, 2006].
  • Empirical treatment should cover Chlamydia trachomatis, the infection most commonly associated with urethritis (see the section on Treatment in the CKS topic on Chlamydia - uncomplicated genital) [NHS Lothian, 2008].
  • Azithromycin and doxycycline are effective in the treatment of chlamydial infection (a cure rate of over 95% has been shown in randomized controlled trials) [Lau and Qureshi, 2002].
    • Azithromycin is given as a single dose, which improves compliance (an important factor to consider for people not likely to return for follow up).

Gonococcal treatment

  • It is not usually possible to accurately clinically distinguish between gonococcal urethritis and non-gonococcal urethritis. Experts suggest that if purulent discharge is present, or there is a known local outbreak of gonorrhoea, then treatment for gonorrhoea should be considered [RCGP and BASHH, 2006; Kurahashi et al, 2007].
  • CKS recommends consulting with a specialist in genito-urinary medicine for advice on appropriate investigations and antibiotic treatment for gonorrhoea.
  • Doxycycline and azithromycin are not recommended to treat Neisseria gonorrhoea, so additional investigation and treatment is required.
    • N. gonorrhoea resistance to tetracycline (in isolates from GUM clinics) was reported to be 68% in 2009 [HPA, 2010]
    • Although Neisseria gonorrhoeae resistance to azithromycin currently remains low [HPA, 2010], there is cause for concern because several of the resistant isolates had high-level resistance. A 2 gram dose of azithromycin is not recommended for the treatment of gonorrhoea because its gastrointestinal adverse effects limit its use [Bignell, 2009]. Although a 1 gram dose is better tolerated, there are concerns that this lower dose will select resistance, so its use is not recommended [CDC, 2006].
  • For more information, see the CKS topic on Gonorrhoea.

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