SEXUALLY TRANSMITTED DISEASES: TREATMENT OF URETHRITIS

Treatment of Gonococcal Urethritis

Because of resistance, the CDC does not recommend the use of fluoroquinolones for infections acquired in Asia or the Pacific (including Hawaii). In addition, the CDC has stated that it is "probably inadvisable" to use fluoroquinolones for infections acquired in California. Antibiotics for the treatment of gonococcal infection include cefixime (Suprax), ceftriaxone (Rocephin), ciprofloxacin (Cipro), levofloxacin (Levaquin), and ofloxacin (Floxin).

Alternative antibiotics for N. gonorrhoeae infection include spectinomycin, ceftizoxime, cefoxitin (with probenicid), cefotaxime, gatifloxacin, norfloxacin, and lomefloxacin. Since co-infection with C. trachomatis occurs in 10% to 30% of gonococcal urethritis cases, treatment for both infections should be provided. A single 2 g dose of azithromycin treats both gonococcal and chlamydial infection, but this is not recommended by the CDC, presumably because of the significant gastrointestinal side effects. Instead, the CDC recommends combining the regimens for gonococcal and nongonoccal urethrits.

Treatment of Nongonococcal Urethritis

The first-line regimens for the treatment of nongonococcal urethritis are either azithromycin Zithromax) in a single 1 g oral dose or doxycycline 100 mg orally twice daily for 7 days. Clearly, azithromycin is a better choice if compliance is an issue, and it even offers the opportunity for directly observed therapy. Alternative treatments for nongonococcal urethritis are 7-day regimens of erythromycin, ofloxacin (Floxin), or levofloxacin (Levaquin). Patients who have persistent symptoms (without treatment) and negative findings on tests for N. gonorrhoeae and C. trachomatis are generally treated for nongonococcal urethritis.