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Recommended Regimen of Urethritis Empiric Therapy

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Empiric therapy or antibiotics can be used to treat urethritis or inflammation of the urethra. This article describes in detail urethritis empiric therapy.

Published At December 2, 2022
Reviewed AtFebruary 23, 2024

What Is the Meaning of Urethritis?

Urethritis is a condition wherein the urethra becomes swollen and inflamed. The urethra is a tube that transports urine from the urinary bladder to the outside of the body. Males also produce a liquid known as semen that passes through the urethra. The most typical symptom of urethritis is pain while urinating and a strong urge to pass urine. Bacterial entry and infection into the urinary tract or urethra is the most common cause of urethritis. Urethritis must not be confused with urinary tract infections because the two are entirely different. Urethritis is a condition wherein the inflammation is confined to the urethra. In contrast, urinary tract infections involve the entire urinary system. Though the patient experiences similar symptoms in urethritis and urinary tract infections, the management strategy varies for both. The treatment is done based on the causes of urethritis. Urethritis can affect people of all age groups, including children and adults. In addition, it can affect both males and females, but females are more likely to develop urethritis because of the anatomical differences in the urinary tract. Females have a shorter urethra than males, so bacteria can easily invade their urogenital tracts.

What Are the Causes of Urethritis?

Most urethritis occurs due to bacterial and viral infections, bacteria being the most common cause. The bacteria that affect the bladder and kidneys can also infect the lining of the urethra. Sometimes, the bacteria present in the genitals might enter the urethra and infect it. The bacteria responsible for urethritis are listed below:

  • Neisseria gonorrhea.

  • Chlamydia trachomatis.

  • Mycoplasma genitalium.

The viruses that can cause urethritis are listed below:

  • Herpes simplex virus.

  • Trichomonas (a unicellular organism that gets transmitted sexually).

What Are the Signs and Symptoms of Urethritis?

The following symptoms are usually seen in males:

  • Penile discharge.

  • Burning sensation while passing urine.

  • Burning or itching near the penile opening.

  • Blood in the urine and semen.

The following symptoms are usually seen in females:

  • Frequent urge to pass urine.

  • Burning and itching sensation at the urethral opening.

  • Pain and discomfort while passing urine.

  • Abnormal vaginal discharge.

What Are the Different Types of Urethritis?

Urethritis can be classified into two different types based on its causes. The two different types of urethritis are listed below:

  1. Gonococcal Urethritis - It is caused by the bacteria Neisseria gonorrhea, and 20 % of the cases of urethritis belong to this type.

  2. Nongonococcal Urethritis - It is caused by infections other than gonorrhea. Chlamydia is one of the most common causes of non-gonococcal urethritis and other sexually transmitted diseases.

Who Is at Risk of Urethritis?

Urethritis is mainly linked to a person's behavior and daily habits, like not maintaining adequate genital hygiene and having unprotected intercourse. The following people are at the highest risk of urethritis:

  • Having multiple sexual partners.

  • Having sexual intercourse without a condom.

  • Previous history of sexually transmitted diseases.

How Is Urethritis Diagnosed?

It is challenging for doctors to diagnose urethritis because the signs and symptoms resemble many other urologic conditions. However, the diagnosis of urethritis is based on the following:

  • Medical History - A medical history is a verbal communication between a doctor and the patient to get an idea about the patient's general health, the signs and symptoms, and the other medical conditions he is suffering from.

  • Physical Examination - A physical examination is done to check the physical signs of urethritis. The doctor will examine the rectum, abdomen, and genitals of the patient.

  • Urine Test - A urine test is a simple procedure in which the patient collects urine in a container. The urine sample is then examined in the laboratory under a microscope to detect bacteria, white blood cells, and other abnormalities.

Empiric therapy is simply a medical term used to describe a therapy that is based on clinical experience and research. There is no complete or perfect information available related to the therapy. The empiric therapy regimen recommended for urethritis is described below:

1. If diagnostic tools are unavailable to treat patients with effective drug regimens, the empiric therapy regimen is listed below:

  • A single dose of Azithromycin 1 g or Doxycycline 100 mg for seven days plus an intramuscular infusion of Ceftriaxone 250 mg or Cefixime 400 mg.
  • Fluoroquinolones must not be used in empiric therapy.

2. Non-gonococcal Urethritis:

  • First-line Regimen:

    • A single dose of Azithromycin 1 g.

    • Doxycycline 100 mg for seven days.

  • Alternative Regimen:

    • Erythromycin base 500 mg.

    • Erythromycin ethylsuccinate 800 mg four times a day for seven days.

    • Ofloxacin 300 mg twice a day for seven days.

    • Levofloxacin 500 mg once daily for seven days.

3. Recurrent and Persistent Urethritis:

  • Recommended Regimens:

    • Single dose of Metronidazole 2 g.

    • Tinidazole 2 g and Azithromycin 1 g.

What Are the Complications of Urethritis?

Medications can treat urethritis quickly and effectively. However, the problem arises when the condition is left untreated for a long period, and the infection spreads to the other parts of the urinary tract, including the kidneys, ureters, and urinary bladder. The infections might turn painful. Although the infections can be treated with more intensive antibiotics, organ damage is always risky. Sometimes, the infection might spread into the blood resulting in a condition known as sepsis or septicemia.

If urethritis occurs due to sexually transmitted infections, it can damage the male and female reproductive tract. Women might develop pelvic inflammatory disease, due to which they experience pelvic pain, infertility, and pain during sexual intercourse. Women who have not undergone any treatment for sexually transmitted infections are at risk of developing ectopic pregnancies, which can be life-threatening. Men are more likely to develop painful inflammation and infection of the prostate gland. The problems arise when a section of the urethra narrows, leading to scarring and painful urination.

How Can Urethritis Be Prevented?

Most bacteria that cause urethritis might get transmitted from one person to another during sexual intercourse. Therefore it is important to practice safe sex. The following tips help prevent urethritis:

  • Avoid having sexual intercourse with multiple partners.

  • Do not engage in sexual activities without using a condom.

  • Avoid having sex if you or your partner is suffering from sexually transmitted diseases.

  • Drink plenty of water to flush out the bacteria from the urinary tract.

  • Limit the consumption of acidic foods.

  • Avoid exposure to spermicides.

  • Cranberry juice contains proanthocyanidins and is considered good for health and beneficial for people suffering from urologic diseases.

  • The patient can take an over-the-counter drug like Pyridium.

  • Do not use scented products or soaps in the genital area.

  • Limit the consumption of salts, alcohol, caffeinated drinks, artificial sweeteners, tomatoes, and spicy foods.

Conclusion:

Urethritis is a common urologic condition that can affect both males and females of any age group. Antibiotics or empiric therapy is the first line of treatment for urethritis because it is mainly caused due to bacterial infection. Several preventive measures are available to treat urethritis in the mild stage. Though urethritis is not a life-threatening condition, the patient must get treated soon as the infection might spread in the blood and result in sepsis. Doctors prefer empiric therapy to treat urethritis because it saves the patient from surgical trauma. Hence the patient need not worry and consult the doctor at the earliest to know about the management of urethritis.

Frequently Asked Questions

1.

What Is the Most Preferred Antibiotic for Urethritis?

A few of the drug regimens followed for urethritis are:
- Azithromycin 1 gram or Doxycycline 100 milligrams for seven days followed by a combination of Ceftriaxone 250 milligrams or Cefixime 400 milligrams can be administered intramuscularly (IM).
- Non-Gonococcal Urethritis: Azithromycin 1 gram (first-line treatment), Erythromycin 400 milligrams (as an alternative regimen).
- Recurrent Urethritis: Metronidazole 2 grams single dose and Azithromycin 1 gram.

2.

What Is the Empiric Management for Urethritis in Men?

Empirical therapy for the treatment of urethritis in men involves:
- Azithromycin 1 gram or Doxycycline 100 milligrams can be prescribed.
- Ceftriaxone 250 milligrams or Cefixime 400 milligrams can be administered intramuscularly (IM).

3.

What Are Empiric Antibiotics for Sexually Transmitted Infections?

Empirical therapy regimens for the management of sexually transmitted infections are:
- Doxycycline 100 milligrams can be prescribed for a week.
- Azithromycin single dose of 1 gram followed by 500 milligrams once a day for two days.

4.

What Is the Best Empiric Antibiotic Therapy?

According to the research few drug combinations are considered as best empiric therapy like:
- Combination of Vancomycin and Meropenem.
- Combination of Vancomycin and Gentamicin.
- Combination of Glycopeptide and Co-Amoxyclav.
- Combination of Glycopeptide and Ciprofloxacin.
- Combination of Glycopeptide and Tazobactam.

5.

Is Doxycycline Considered an Empiric Antibiotic?

Doxycycline belongs to the group of Tetracycline drugs and has been approved for empirical therapy for the management of mild to moderate pneumonia (community-acquired) in hospitalized patients according to the research. The drug Doxycycline is quite reasonable and effective for the empirical management of mild infections.

6.

Can Ciprofloxacin 500 mg Cure Urethritis?

Ciprofloxacin belongs to the group of drug Fluoroquinolones. The drug Ciprofloxacin in the dosage of 500 milligrams in a single dose is quite effective in the management of uncomplicated gonococcal urethritis in men according to the research. However, Fluoroquinolones are not a preferred drug for empirical therapy.

7.

Does Azithromycin Treat Urethritis?

Yes, Azithromycin in a single dose of 1 gram followed by 500 milligrams once a day for two days is used in the management of gonococcal urethritis. Azithromycin is also a preferred drug for empirical therapy and the first line of drug for the management of non-gonococcal urethritis.

8.

Can Azithromycin Treat Urethritis Alone?

Azithromycin in a single dose of 1 gram was reported to be effective in the management of non-gonococcal urethritis and has proven to have a similar effect as Doxycycline standard drug therapy for seven days.

9.

Can Cefixime Manage Urethritis?

Intramuscular (IM) administration of the drug Cefixime in a dose of 400 milligrams is used as an empirical therapy for the management of gonococcal urethritis in men. It is usually given following other drugs like Azithromycin and Doxycycline for seven days as an empirical therapy. 

10.

Is Levofloxacin Better for Urethritis?

Levofloxacin in the dosage of 500 milligrams once daily for a week can be prescribed for the management of non-gonococcal urethritis. It is considered an alternative regimen drug. The drug Levofloxacin is quite effective and safe for the management of urethritis.

11.

Will Amoxicillin Cure Urethritis?

Amoxicillin 2 grams can be used for the management of uncomplicated acute gonococcal urethritis in men. However, it is not a first-line drug for the management of urethritis. According to research, few cases of re-exposure and untreated urethritis were reported even after the treatment with Amoxicillin.

12.

Which Is Better for Urinary Tract Infections Cipro or Levofloxacin?

Both drugs Ciprofloxacin and Levofloxacin have proven to be equally effective in the management of urinary tract infections. However, based on efficacy, adverse events, and occurrence of disease Levofloxacin has an added advantage over Ciprofloxacin.

13.

What Is the Second-Line of Management of Urethritis in Adults?

Second-line management of urethritis in adults involves alternate drugs like:
- Erythromycin base 500 milligrams.
- Ofloxacin 300 milligrams twice a day.
- Moxifloxacin 400 milligrams for a week.
- Levofloxacin 500 milligrams once a day for a week.
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Dr. Samer Sameer Juma Ali Altawil
Dr. Samer Sameer Juma Ali Altawil

Urology

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