Treatment of Urethritis

The incidence of urethritis is raised in the last 10 years with a peak of incidence in the age range 25–29 years. This phenomenon is due to the increased risk factors, such as multiple and/or simultaneous sexual relationships, lack of condom during sexual intercourses, alcohol, and drug abuse. Moreover, migratory streams from North Africa to Europe may contribute to reactivate epidemiological risks for new strains of gonococcal urethritis. Empirical treatments are no more recommended, although broad-spectrum antibiotic treatments may be used in those patients with severe symptoms that are still waiting for appropriate microbiological characterization of urethral discharge by nucleic acid amplification test (NAAT). Combined ceftriaxone and azithromycin single-dose treatment is indicated for gonococcal urethritis due to the widespread high level of cephalosporin resistance. Treatment of non-gonococcal urethritis is related to the specific microorganism characterization. Macrolides seems to be effective in general against Chlamydia trachomatis, Ureaplasma urealyticum, and Mycoplasma genitalium spp., but metronidazole or Tinidazole-based therapy is necessary in the case of infections by Trichomonas vaginalis. Behavioral recommendations are relevant for affected men and their partners during the period of treatment. Patients with non-gonococcal urethritis should be monitored after the antibiotic treatment, and microbiological investigations should be adequately repeated after 3 months due to the high risk of reinfection.