# Male Urethritis (Acute) - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - Sources: CDC Sexually Transmitted Infections Treatment Guidelines, 2021 (MMWR Recomm Rep 2021;70(4):1-187; PMC8344968), Gonococcal Infections - Uncomplicated Gonococcal Infection of the Cervix, Urethra, or Rectum (doses) and Urethritis (empiric treatment) · BASHH UK National Guideline for the Management of Urethritis 2018 · CDC Sexually Transmitted Infections Treatment Guidelines, 2021 (MMWR Recomm Rep 2021;70(4):1-187; PMC8344968), Nongonococcal Urethritis - Recommended Regimen · Egyptian National Drug Formulary - Antimicrobial 2023 (Version 1.0), cefixime monograph, Indications ("Uncomplicated cervical/urethral gonorrhea") and Dosage Regimen, Dosing: Adult, Usual dosage range · Urethritis in men - disease-level clinical article (urethritis-male-full.txt) - Verified date: 2026-08 ## Verified against - CDC Sexually Transmitted Infections Treatment Guidelines, 2021 (MMWR Recomm Rep 2021;70(4):1-187; PMC8344968), Gonococcal Infections - Uncomplicated Gonococcal Infection of the Cervix, Urethra, or Rectum (doses) and Urethritis (empiric treatment) - BASHH UK National Guideline for the Management of Urethritis 2018 - CDC Sexually Transmitted Infections Treatment Guidelines, 2021 (MMWR Recomm Rep 2021;70(4):1-187; PMC8344968), Nongonococcal Urethritis - Recommended Regimen - Egyptian National Drug Formulary - Antimicrobial 2023 (metronidazole monograph, trichomoniasis) - Urethritis in men - disease-level clinical article (urethritis-male-full.txt) - Egyptian National Drug Formulary - Antimicrobial 2023 (Version 1.0), cefixime monograph, Indications ("Uncomplicated cervical/urethral gonorrhea") and Dosage Regimen, Dosing: Adult, Usual dosage range ## Treatment metadata - Ceftriaxone — 500 mg — injection - Doxycycline — 100 mg — oral.solid - Azithromycin — 1000 mg — oral.solid - Metronidazole — 500 mg — oral.solid - Cefixime — 400 mg — oral.solid ## Complete treatment card ```text MALE URETHRITIS (ACUTE) Sources: CDC Sexually Transmitted Infections Treatment Guidelines, 2021 (MMWR Recomm Rep 2021;70(4):1-187; PMC8344968), Gonococcal Infections - Uncomplicated Gonococcal Infection of the Cervix, Urethra, or Rectum (doses) and Urethritis (empiric treatment) · BASHH UK National Guideline for the Management of Urethritis 2018 · CDC Sexually Transmitted Infections Treatment Guidelines, 2021 (MMWR Recomm Rep 2021;70(4):1-187; PMC8344968), Nongonococcal Urethritis - Recommended Regimen · Egyptian National Drug Formulary - Antimicrobial 2023 (Version 1.0), cefixime monograph, Indications ("Uncomplicated cervical/urethral gonorrhea") and Dosage Regimen, Dosing: Adult, Usual dosage range · Urethritis in men - disease-level clinical article (urethritis-male-full.txt) Review status: REVIEWED against 4 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (12) - Urethritis often causes no symptoms at all, especially in women - 25-40% of men with nongonococcal urethritis have no symptoms - Frank purulent discharge points toward gonorrhea, while dysuria alone is more typical of chlamydia [burning on passing urine · pus] - Dysuria together with painful genital ulcers suggests herpes simplex virus as the cause [burning on passing urine · genital ulcers] - In men, dysuria is usually felt at the tip of the penis, worst on the first morning void, and worsened by alcohol [burning on passing urine] - Testicular pain can accompany urethritis [testicular pain] - A thick yellow-green discharge points toward gonorrhea - A thick but clear-to-whitish discharge points toward chlamydia instead - Adenovirus causes intense dysuria rather than the itching or irritation typical of other nongonococcal causes [burning on passing urine] - Adenovirus urethritis often comes with cold-like upper respiratory symptoms in fall or winter, typically with no visible discharge - HSV causes intense dysuria [burning on passing urine] - Painful ejaculation and soreness at the meatus can accompany symptomatic chlamydial infection SIGNS - what you find (5) - Gently milking the penis from base to tip can express a discharge sample for testing - Scant serous discharge along with meatitis and balanitis is a typical exam finding in gonococcal urethritis - Waiting at least 2 hours since the last void before examining improves the chance of finding a discharge - A small amount of discharge, along with meatitis and balanitis, may be seen on exam with herpes simplex urethritis - Herpetic lesions may not be visible at the first exam but often appear shortly after TESTS (9) - Diagnosis is confirmed by mucopurulent discharge at the meatus, 2 or more white cells per oil- immersion field on gram stain, or a positive leukocyte esterase / 10 or more white cells per high-power field on first-voided urine without a UTI - Urinalysis alone can't diagnose urethritis, and over 30% of nongonococcal cases show no white cells in the urine - NAAT testing for chlamydia and gonorrhea is standard for everyone diagnosed with this - A wet mount for trichomonas loses sensitivity fast, dropping to just 20% if not read within an hour - NAAT for trichomonas runs 95-100% sensitive and specific - Gram stain and the newer MB/GV smear both run about 97% sensitive and 99.6% specific for gonococcal infection against culture - In sexually active young women, pyuria without bacteria on urinalysis strongly suggests chlamydial infection - NAAT is the only reliable test for Mycoplasma genitalium since it's very hard to culture - Mycoplasma genitalium coexists with gonorrhea or chlamydia in about 20% of cases IF NOT THIS - what else fits (4) - Reactive arthritis features joint inflammation, conjunctivitis, and urethritis together, though few patients show the full triad, and urethritis usually comes first - Reactive arthritis typically follows a gut or genital infection, often chlamydia, by days to weeks - In men, prostatitis, epididymitis, cystitis, proctitis, orchitis, chancroid, HPV, urethral trauma, or strictures can mimic this - Some cases of dysuria have no identifiable cause at all Source StatPearls "Urethritis" - disease-level clinical article Status traced to the source above !! MULTI-DRUG REGIMEN - all 2 drugs are given TOGETHER. Not a choice between them. !! the regimen: Ceftriaxone + Doxycycline Rx: Main treatment | Trichomonal urethritis - index case and sex partner | Oral cephalosporin - alternative gonococcal regimen when IM ceftriaxone is unavailable MAIN TREATMENT - choose one 1. CEFTRIAXONE [1 of 2 - GIVE ALL TOGETHER] Adult 500 mg IM single dose PLUS Doxycycline 100 mg BID for 7 days for empiric treatment of acute male urethritis - single IM dose Peds Specialist pediatric adolescent medicine referral AWaRe WATCH group - carries resistance cost. Egyptian EML 2025. Source CDC Sexually Transmitted Infections Treatment Guidelines, 2021 (MMWR Recomm Rep 2021;70(4):1-187; PMC8344968), Gonococcal Infections - Uncomplicated Gonococcal Infection of the Cervix, Urethra, or Rectum (doses) and Urethritis (empiric treatment) Why Third-generation cephalosporin that covers Neisseria gonorrhoeae, given together with doxycycline as empiric dual therapy for acute male urethritis before culture results are available, since gonococcal and chlamydial infection cannot be distinguished clinically. Caution Reconstitute with 1% lidocaine for IM injection to reduce pain. Notify and treat sex partners from past 60 days. Perform urethral swab or first-void urine NAAT for N. gonorrhoeae and C. trachomatis prior to therapy. Egypt TRIXOMASH 500MG VIAL FOR I.V. INJ. RAMEDA > MASH PREMIERE 16.50 EGP WINTRIAXONE 500 MG PD. FOR I.V INJ. SANOFI 21.75 EGP CEFAXONE 500MG I.V. VIAL PHARCO B 25.25 EGP TRIAXONE 500MG VIAL FOR I.M. INJ. TABUK PHARMACEUTICAL MANUFACTURING COM... 36.00 EGP TRIAMERICAN 500 MG I.M. VIAL RAMEDA > PAXAL 46.00 EGP EPICEPHIN 500 MG I.V. VIAL EIPICO 47.00 EGP CEFAXOTREZ 500 MG I.M. VIAL RAMEDA > BOST... 63.00 EGP CEFAXOTREZ 500 MG I.V. VIAL RAMEDA > BOST... 63.00 EGP 2. DOXYCYCLINE [2 of 2 - GIVE ALL TOGETHER] Adult 100 mg twice daily for 7 days co-administered with Ceftriaxone for Chlamydia coverage x 7 days Peds Not recommended under 8 years of age. The Egyptian National Drug Formulary - Antimicrobial 2023, doxycycline monograph, sets the same limit: below 8 years the drug should be held back for infections that are severe or life-threatening, or for cases where nothing better is available. Source CDC Sexually Transmitted Infections Treatment Guidelines, 2021 (MMWR Recomm Rep 2021;70(4):1-187; PMC8344968), Nongonococcal Urethritis - Recommended Regimen Why Tetracycline antibiotic that covers Chlamydia trachomatis and other atypical organisms, given alongside ceftriaxone to complete empiric dual coverage of acute male urethritis. Caution Advise completing full 7-day course even if discharge resolves. Abstain from sexual contact until 7 days after starting treatment and symptoms resolve. Egypt FARCODOXIN 100MG 10 CAPS. PHARCO 11.00 EGP (1.10/unit) DOXY M.R.100 MG 10 CAPS. ADWIA 12.00 EGP (1.20/unit) GRANUDOXY 100MG 10 F.C. TAB. GLOBAL NAPI P... 12.00 EGP (1.20/unit) DOXYDOX 100 MG 10 CAPS. EIPICO 23.00 EGP (2.30/unit) DOXYMYCIN 100 MG 10 CAPS. EL NILE. 30.00 EGP (3.00/unit) TABOCINE 100MG 10 CAPS. TABUK PHARMAC... 46.00 EGP (4.60/unit) VIBRAMYCIN 100MG 10 CAPS. PFIZER 65.00 EGP (6.50/unit) 3. AZITHROMYCIN [2nd line] Adult 1 g single oral dose (alternative when doxycycline is contraindicated or compliance is doubtful) - single dose Peds Specialist use only AWaRe WATCH group - carries resistance cost. Egyptian EML 2025. Source BASHH UK National Guideline for the Management of Urethritis 2018 Why Macrolide alternative to doxycycline for chlamydial coverage in acute male urethritis, used when doxycycline is contraindicated or adherence is doubtful; it replaces only the chlamydia-covering half of therapy - ceftriaxone is still required for gonorrhoea. Caution This replaces the doxycycline half of the regimen, not the ceftriaxone. The injection covers gonorrhoea and is still needed. There are high rates of Mycoplasma genitalium macrolide resistance with single-dose azithromycin. Gastrointestinal side effects (nausea, abdominal cramps) are common. Egypt AZIROWA 1000 MG 2 F.C. TABS. AL ROWAD PHAR... 44.00 EGP (22.00/unit) ZITHRODOSE 100MG/5ML SUSP. 15ML EL-OBOUR > AV... 12.00 EGP -> ? strength differs, ? different route - not oral solid ZITHROPHATE 200MG/5ML SUSP. 15ML ORGANO PHARMA... 12.75 EGP -> ? strength differs, ? different route - not oral solid TRICHOMONAL URETHRITIS - INDEX CASE AND SEX PARTNER 4. METRONIDAZOLE [2nd line] Adult 500 mg twice daily x 7 days Peds Not applicable - a sexually transmitted infection in adult men. Source Egyptian National Drug Formulary - Antimicrobial 2023 (metronidazole monograph, trichomoniasis) Why The card covered gonococcal and chlamydial urethritis (ceftriaxone, doxycycline, azithromycin) and had nothing for Trichomonas vaginalis, which the disease article names as a cause in men. The article suggests a single dose; the ENDF's only trichomoniasis regimen is 500 mg twice daily for 7 days, explicitly for the index case and the sex partner, so that is the dose written here and the single-dose regimen is not. Caution Hypersensitivity to metronidazole, nitroimidazole derivatives, or any component of the formulation Pregnant patients (first trimester) with trichomoniasis Use of disulfiram within the past 2 weeks; use of alcohol or propylene glycol-containing products during therapy or within 3 days of therapy discontinuation Active neurological disorders; history of blood dyscrasia; hypothyroidism; hypoadrenalism Egypt DUMOZOL 500MG 20 F.C. TABS. MINA PHARM > ... 7.00 EGP (0.35/unit) ZOLGUARD 500MG 20 TAB. UNIPHARMA CO.... 9.00 EGP (0.45/unit) NITROFECTAZOLE 500 MG 20 F.C. TABS. GYPTO PHARMA 10.50 EGP (0.53/unit) FLAGICURE FORTE 500 MG 20 F.C. TAB KAHIRA 23.00 EGP (1.15/unit) TRICHOGYL 500MG 12 F.C.TAB. EL NASR 15.00 EGP (1.25/unit) FLAGELLAT FORTE 500MG 20 F.C.TABS. MUP 30.00 EGP (1.50/unit) GEDAZOLE 500MG 20 TAB. JEDCO INT. CO... 34.00 EGP (1.70/unit) METROGYPTON 500 MG 20 F.C. TABS. GYPTO PHARMA 34.00 EGP (1.70/unit) DUMOZOL 125MG/5ML SUSP. 125ML MINA PHARM > ... 5.75 EGP -> ? strength differs, ? different route - not oral solid METROZOLE 125MG/5ML SUSP. 120 ML MEMPHIS 19.50 EGP -> ? strength differs, ? different route - not oral solid ORAL CEPHALOSPORIN - ALTERNATIVE GONOCOCCAL REGIMEN WHEN IM CEFTRIAXONE IS UNAVAILABLE 5. CEFIXIME [2nd line] Adult 800 mg orally as a single dose - Single dose Peds 8 mg/kg/day [child max 400 mg] (ENDF, susceptible infection (mild to moderate), infants, children and adolescents: oral 8 mg/kg/day divided every 12 to 24 hours, maximum daily dose 400 mg. That is the formulary's general paediatric dose, not a paediatric gonorrhoea regimen.) 3kg -> 24 mg/day 4kg -> 32 mg/day 5kg -> 40 mg/day 6kg -> 48 mg/day 7kg -> 56 mg/day 8kg -> 64 mg/day 9kg -> 72 mg/day 10kg -> 80 mg/day 11kg -> 88 mg/day 12kg -> 96 mg/day 13kg -> 104 mg/day 14kg -> 112 mg/day 15kg -> 120 mg/day 16kg -> 128 mg/day 17kg -> 136 mg/day 18kg -> 144 mg/day 19kg -> 152 mg/day 20kg -> 160 mg/day 21kg -> 168 mg/day 22kg -> 176 mg/day 23kg -> 184 mg/day 24kg -> 192 mg/day 25kg -> 200 mg/day 26kg -> 208 mg/day 27kg -> 216 mg/day 28kg -> 224 mg/day 29kg -> 232 mg/day 30kg -> 240 mg/day 31kg -> 248 mg/day 32kg -> 256 mg/day 33kg -> 264 mg/day 34kg -> 272 mg/day 35kg -> 280 mg/day 36kg -> 288 mg/day 37kg -> 296 mg/day 38kg -> 304 mg/day 39kg -> 312 mg/day 40kg -> 320 mg/day 41kg -> 328 mg/day 42kg -> 336 mg/day 43kg -> 344 mg/day 44kg -> 352 mg/day 45kg -> 360 mg/day 46kg -> 368 mg/day 47kg -> 376 mg/day 48kg -> 384 mg/day 49kg -> 392 mg/day 50kg -> 400 mg/day AWaRe WATCH group - carries resistance cost. Egyptian EML 2025. Source Urethritis in men - disease-level clinical article (urethritis-male-full.txt) for the adult single dose; the paediatric band is from Egyptian National Drug Formulary - Antimicrobial 2023 (cefixime monograph): "Infants, Children, and Adolescents: Oral: 8 mg/kg/day divided every 12 to 24 hours; maximum daily dose: 400 mg/day", the clinical article being adult-only. Why The card's only gonococcal cover was intramuscular ceftriaxone. The disease article names cefixime among the alternative gonococcal regimens and states its dose in the same sentence - the alternatives it gives are a single 240 mg of gentamicin intramuscularly with 2 g of azithromycin by mouth, or 800 mg of cefixime by mouth - so one trusted document carries both claims. The Egyptian formulary also names uncomplicated cervical or urethral gonorrhoea in cefixime's indications, but gives only a general 400 mg daily range with no gonorrhoea-specific regimen; the international single dose therefore leads and the formulary's figure is quoted on the row. Gentamicin, the other alternative in the same sentence, remains refused: the ENDF's gentamicin indications name serious infections including urinary tract infections, but not gonorrhoea. Caution Hypersensitivity to cefixime, any component of the formulation, or other cephalosporins or penicillins The Egyptian formulary's figure is different and lower - its adult oral range is 400 mg a day, split across doses given 12 to 24 hours apart. It states no gonorrhoea-specific regimen and no duration. The disease article recommends cefixime only as an alternative, and in the same section it says the quinolones and the oral cephalosporins are not recommended, on the grounds of substantial bacterial resistance. Intramuscular ceftriaxone remains the first choice here. Test of cure 7 days after the dose when cefixime is used for gonococcal infection - the Egyptian formulary asks for it. CrCl 21 to 59 mL/minute: 260 mg once daily Egypt HEBIXIME 400MG 5 CAPS. SHIFA MEDICAL... 60.00 EGP (12.00/unit) XIMACEF 400MG 5 CAPSULE SIGMA 63.00 EGP (12.60/unit) WIDEPREX 400 MG 5 CAPS. BIOMED PHARMA... 104.00 EGP (20.80/unit) SUPRAX 400 MG 5 CAPS. KAHIRA > HIKM... 159.00 EGP (31.80/unit) VIODRILNEX 100MG/5ML SUSP. 30ML BADR PHARMA >... 21.50 EGP -> ? strength differs, ? different route - not oral solid CEFABRUM 100MG/5ML SUSP. 60ML ALFACURE PHAR... 27.00 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)