Editing Urethritis (section)

==Treatment==
Antimicrobials are generally the drug of choice for gonococcal and non-gonococcal infections. The CDC in 2015 suggests using a dual therapy that consists of two antimicrobials that have different mechanisms of action would be an effective treatment strategy for urethritis and it could also potentially slow down antibiotic resistance.<ref name = "CDC_2015">{{cite web|date=2019-03-15|title=Gonococcal Infections - 2015 STD Treatment Guidelines|url=https://www.cdc.gov/std/tg2015/gonorrhea.htm|access-date=2020-07-30|website=www.cdc.gov|language=en-us}}</ref>

A variety of drugs may be prescribed based on the cause of urethritis:
* '''Gonococcal urethritis (caused by ''[[Neisseria gonorrhoeae|N. gonorrhoeae]]'')''': The CDC recommends administering an injection dose of [[ceftriaxone]] 250&nbsp;mg intramuscularly and oral dose of [[azithromycin]] 1g simultaneously.<ref name = "CDC_2015" /> [[Cefixime]] 400&nbsp;mg oral single dose can be used as an alternative if [[ceftriaxone]] is not available.
* '''Non-gonococcal urethritis (caused by ''[[Chlamydia trachomatis]]'')''': The CDC recommends administering an oral single dose of [[azithromycin]] 1g or a 7-day course of [[doxycycline]] 100&nbsp;mg orally twice daily.'<ref name = "CDC_2015_TG" />
** Alternative treatments can also be used when the above options are not available:<ref name = "CDC_2015_TG" />
*** [[Erythromycin|Erythromycin base]] 500&nbsp;mg orally four times daily for 7 days
*** [[Erythromycin|Erythromycin ethylsuccinate]] 800&nbsp;mg orally four times daily for 7 days
*** [[Levofloxacin]] 500&nbsp;mg orally once daily for 7 days
*** [[Ofloxacin]] 300&nbsp;mg orally twice daily for 7 days

Treatment for both gonococcal and non-gonococcal urethritis is suggested to be given under direct observation in a clinic or healthcare facility in order to maximize compliance and effectiveness.

For non-medication management, proper [[Perineum|perineal]] hygiene should be stressed. This includes avoiding use of vaginal deodorant sprays and proper wiping after urination and bowel movements. Sexual intercourse should be avoided at least 7 days after completion of treatment (and until symptoms resolves, if present).<ref name = "CDC_2015_TG" /> Past and current sexual partners should also be assessed and treated.<ref name=":1">{{cite web|date=2017-10-23|title=Non-gonococcal urethritis|url=https://www.nhs.uk/conditions/non-gonococcal-urethritis/|access-date=2020-08-02|website=nhs.uk|language=en}}</ref>

Individuals displaying persistence or recurrence of symptoms should be instructed for possible re-evaluation. Although there is no standard definition, persistent urethritis is defined as urethritis that has failed to display improvement within the first week of initial therapy. Additionally, recurrent urethritis is defined as urethritis reappearing within 6 weeks after a previous episode of non-gonococcal urethritis.<ref>{{cite book |last1=Grant|first1=Philip M. |last2=Hooton|first2=Thomas M. | chapter = Chapter 7. Persistent & Recurrent Urethritis|date=2007|url=http://accessmedicine.mhmedical.com/content.aspx?aid=3027260| title = Current Diagnosis & Treatment of Sexually Transmitted Diseases|place=New York, NY|publisher=The McGraw-Hill Companies|access-date=2020-07-31 |editor-last=Klausner|editor-first=Jeffrey D. |editor2-last=Hook|editor2-first=Edward W.}}</ref> If recurrent symptoms are supported by microscopic evidence of urethritis, then re-treatment is appropriate.<ref name = "Moi_2015" /> The following treatment recommendations are limited and based on clinical experience, expert opinions and guidelines for recurrent or persistent [[non-gonococcal urethritis]]:<ref name = "Moi_2015" />
* If [[doxycycline]] was prescribed as initial therapy, give [[azithromycin]] 500&nbsp;mg or 1 gram for the first day, then give [[azithromycin]] 250&nbsp;mg once daily for 4 days plus [[metronidazole]] 400 – 500&nbsp;mg twice daily for 5 days
* If [[azithromycin]] was prescribed as initial therapy, then give [[doxycycline]] 100&nbsp;mg twice daily for 7 days plus [[metronidazole]] 400 – 500&nbsp;mg twice daily for 5 – 7 days
* [[Moxifloxacin]] 400&nbsp;mg orally once daily for 7 – 14 days can be given with use of caution, if macrolide-resistant [[Mycoplasma genitalium|''M. genitalium'']] infection is demonstrated <ref name = "Moi_2015" />

Appropriate treatment for these individuals may require further referral to a [[Urology|urologist]] if symptoms persist after initial treatment.<ref name = "CDC_2015_TG" />