Most cases of
urethritis can be readily treated using recommended regimens. The most important causes of
urethritis are Chlamydia trachomatis and Neisseria gonorrhoeae, and initial treatment is directed at them. Optimal management requires obtaining a thorough sexual history, evaluation for objective clinical and laboratory evidence of
infection, antimicrobial
therapy directed towards the major aetiologies, and evaluation and treatment of sexual partners. Treatment of gonorrhoea requires a single-dose regimen active against N. gonorrhoeae, plus a regimen active against C. trachomatis and nongonococcal
urethritis. The usually recommended treatment for N. gonorrhoeae is a single dose of
ceftriaxone 250mg intramuscularly, but there are many alternatives, including oral ones. Only in very restricted geographical areas and under restricted situations are
penicillins still reliable against N. gonorrhoeae. Recommended optimal treatment of C. trachomatis or nongonococcal
urethritis currently requires 7 days' treatment with a
tetracycline. Some guidelines now propose
ofloxacin 300 mg orally twice daily for 7 days as an equivalent alternative, and there are very promising data with a single dose
therapy with
azithromycin, a long-acting
macrolide antimicrobial. Using recommended regimens, microbiological failure is infrequent in compliant patients. Recurrent
urethritis is, however, frequent. For patients who receive recommended treatment and do well, no follow-up cultures are needed. Patients with persistent or recurrent symptoms require careful re-evaluation of the patient, documentation of
urethritis, and
retreatment with
antimicrobial agents a second time if
urethritis is documented by positive cultures or increased numbers of polymorphonuclear leucocytes in urethral secretions.(ABSTRACT TRUNCATED AT 250 WORDS)