Treatment of Urethritis in Men

Urethritis in men is caused by many different types of organisms and ideal treatment would be to identify the infecting organism and treat it with specific antibiotics highly effective in treating such infection. But it may not be possible in every cases of urethritis. In practice after diagnosing a case of urethritis in men, initially Gram’s staining is done, if it reveals gonococci, treatment for gonococci is done and if it does not reveal gonococci than treatment for NGU (nongonococcal urethritis) is done.

Treatment of gonococci infection:

Gonococci infection is treated with cephalosporin antibiotics. Among cephalosporin antibiotics ceftriaxone (125 mg intramuscularly single dose), cefpodoxime (400 mg orally single dose) or cefixime (400 mg orally single dose) can be used.

If no diagnostic test is available or performed in a patient with urethritis, than treatment regimen should be single-dose regimen for gonorrhea (as above) plus azithromycin (1 gram orally as single dose) or doxycycline (100 mg twice a day for 7 days) for treatment of clamidial infection (C. tracomatis) which occurs frequently in patients suffering from urethritis due to gonococci.

If gonococci are not demonstrated by Gram’s staining, it should be treated as NGU (nongonococcal urethritis) like azithromycin (1 g orally in a single dose) or doxycycline (100 mg orally 2 times a day for 7 days).

How to treat recurrent cases of urethritis?

Recurrent cases of urethritis should be treated with the same regimen as before if they did not comply with the earlier treatment or if they are reexposed to same infection. If the patient was treated appropriately previously, than an intraurethral swab specimen and a first-voided morning urine sample should be tested (culture of the swabs and antibiotic sensitivity done). If compliance to the initial treatment can be confirmed and reexposure excluded (in persistent cases) the treatment should include metronidazole or tinidazole (2 gram orally in a single dose) plus azithromycin (1 gram orally in a single dose).

N.B.- The sexual partner/partners (should be tested for gonorrhea and chlamydial infection) also should be treated with the same regimen as given to the male urethritis patient.

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