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.

• If symptoms have improved but have not completely resolved and provided treatment has been adhered to and sexual intercourse with an untreated partner has not occurred, explain that symptoms may take 2–3 weeks to resolve, despite effective treatment.
• If the man has not adhered to treatment or has had sexual intercourse with an untreated partner, re-treat (with azithromycin 1 gram as a single dose, or doxycyline 100 mg twice a day for 7 days) with appropriate partner notification.
• If symptoms have not improved 1–2 weeks after treatment (or have not completely resolved 2–3 weeks after treatment) and the man has adhered to treatment and has not had sex with an untreated partner:
• Exclude other causes of urethritis (such as trauma and irritation), or other diagnoses (such as prostatitis or malignancy).
• Discuss with the local genito-urinary medicine clinic and advise the man that referral is appropriate. If the man refuses to attend a specialist centre, consider:
• Azithromycin 500 mg dose once only, then 250 mg for the next 4 days, plus metronidazole 400 mg to 500 mg twice daily for 5 days.