Internal Medicine

0521779407-21 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:59

1490 Urethritis

General Measures

■Patients should be informed of importance of using barrier contra-

ceptives to prevent sexually transmitted diseases.

■They should be counseled about HIV and informed of the increased

likelihood of HIV transmission with urethritis.

■All sexual partners within 60 days of patients with urethritis should

be referred for examination and treatment.

■Women <25 who are sexually active or women >25 who have new or

multiple partners should have screening tests for both Chlamydia

and gonorrhea.

specific therapy

■All who have 5 or more leukocytes per oil immersion field in urethral

fluid or sexual contact within the last 60 days with a person who has

urethritis should be treated.

➣Give empiric treatment for high-risk patients who are unlikely to

return for follow-up.

Treatment Options

■If the results of the nucleic acid amplification tests are not available,

then patients should be treated with both ceftriaxone 125 mg IM

in a single dose PLUS azithromycin 1 g orally in a single dose or

doxycycline 100 mg orally twice a day for 7 days.

■Alternatively, ofloxacin bid or levofloxacin once daily for 7 days can

be administered (but fluoroquinolone-resistant gonorrhea has been

reported in Southeast Asia, Hawaii, California, New England and in

men who have sex with men).

■If patients have recurrent or persistent urethritis, have a wet mount

examination that shows trichomonas, or if an etiology is not deter-

mined, they should receive metronidazole p.o. in a single dose plus

erythromycin qid for 7 days unless noncompliant with previous reg-

imen.

■Side Effects & Contraindications

■Ceftriaxone

➣Side effects: rarely allergic reactions

➣Contraindications

Absolute: a patient who is allergic to penicillin

■Doxycycline

➣Side effects: nausea, vomiting, diarrhea, photosensitivity on

exposure to sun

➣Contraindications