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Author: Admin | 2025-04-28
Respond well to antimicrobial treatment, suggesting false-negative tests or the presence of unknown pathogens.19 Noninfectious causes of urethritis are poorly defined in the medical literature. Treatment In patients with confirmed urethritis, concurrent treatment for gonorrhea and chlamydia is recommended unless test results are already known or rapid results can be obtained to narrow treatment. Current CDC recommendations for these infections are listed in Table 2.16 The combination of a single 1-g dose of oral azithromycin (Zithromax) or 100 mg of oral doxycycline twice per day for seven days (for chlamydia) plus either 400 mg of oral cefixime (Suprax) or 125 mg of intramuscular ceftriaxone (Rocephin; for gonorrhea) is the primary treatment.16 Because of increased resistance, fluoroquinolones are no longer recommended for empiric treatment of gonorrhea. Although fluoroquinolones may succeed if used inadvertently, a test of cure is suggested in these cases. In men with urethral symptoms but no objective signs or findings, treatment generally should be deferred until test results are available. Exceptions include patients at high risk of STIs who are unlikely to return for test results and treatment. Men returning for evaluation of persistent or recurrent urethral symptoms can be challenging to diagnose and treat. Considerations include a recurrent infection, usually because of a lack of simultaneous treatment of partners or reinfection by a new partner; an untreated infection, such as Mycoplasma, Ureaplasma, Trichomonas, HSV, Enterobacteriaceae, or adenovirus; a resistant organism; or a noninfectious cause. Azithromycin is the drug of choice for mycoplasmal, ureaplasmal, and chlamydial infections.20 Azithromycin may also be effective in patients who test negative for these pathogens, with one Japanese study showing an 85 percent cure of signs and symptoms.19 Emergence of azithromycin resistance in Mycoplasma has been demonstrated, leading to a suggestion of longer or alternative treatment for persistent cases.21 In areas with a
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