III. Symptoms

  1. Urethral discharge
  2. Dysuria

IV. Differential Diagnosis

V. Labs

  1. See Sexually Transmitted Infection
  2. Gonorrhea PCR
  3. Chlamydia PCR
  4. Trichomonas PCR or Wet Prep
  5. Mycoplasma Genitalium NAAT may be available (esp for persistent or recurrent symptoms)

VI. Management

  1. Precaution
    1. See Dysuria for a more complete protocol for evaluation and management
    2. Also give Ceftriaxone 500 mg IM/IV for 1 dose (1 gram IM/IV if weight > 150 kg) if Gonorrhea not excluded
  2. First-Line (empiric for Chlamydia AND Trichomonas)
    1. Azithromycin 1 gram for one dose AND
    2. Metronidazole 2 grams for one dose
  3. Alternative regimen
    1. Doxycycline 100 mg orally twice daily for 7 days AND
    2. Tinidazole 2 grams for one dose
  4. Persistent Urethritis
    1. See Dysuria
    2. Consider resistant Mycoplasma Genitalium
      1. See Mycoplasma Genitalium for treatment regimen
      2. Consider Moxifloxacin 400 mg orally daily for 10 days (after initial Doxycycline course)

VII. Resources

  1. Non-Gonococcal Urethritis (Stat Pearls)
    1. https://www.ncbi.nlm.nih.gov/books/NBK535411/

VIII. References

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