Persistent or recurrent NGU (non - gonococcal urethritis)

Is defined as persistent or recurrent symptomatic urethritis occurring 30-90 days following treatment of acute NGU. It is seen in around 10%-20% of patients.

Aetilogy is most likely to be multifactorial but M. genitalium (found in 20%-40%) and U. urealyticum have been implicated.

Before starting treatment

• reinfection should be ruled out and make certain that the patient has taken the full course of therapy initially prescribed
• definite symptoms of urethritis (or physical signs on examination) should be present

In patients with symptoms or obvious discharge recommended regimens include:

• 1st line
  • Azithromycin 500mg stat then 250mg for the next 4 days plus Metronidazole 400 mg twice daily for 5 days
  • or
    • Erythromycin 500 mg four times daily for 3 weeks plus Metronidazole 400mg twice daily for 5 days
• 2nd line
  • Moxifloxacin 400mg orally once daily for 10 days plus Metronidazole 400mg twice daily for 5 days (1)

Reference:

• 1. British Association for Sexual Health and HIV. 2007 UK National Guideline on the Management of Nongonococcal Urethritis