Moxifloxacin remains effective for macrolide-resistant M. genitalium
Zoliflodacin (novel antibiotic) in clinical trials for gonorrhea
Public health implications
Ceftriaxone is last reliable single-agent gonorrhea therapy
Surveillance for cephalosporin-resistant N. gonorrhoeae ongoing (CDC GISP program)
Point-of-care and expedited care strategies
Empiric treatment at first visit
Reduces transmission during results pending period
Does not require culture for initial management decision
Expedited partner therapy (EPT)
Prescribing or dispensing medication for partner without clinical evaluation
Permitted in most US states with variable legal frameworks
Reduces reinfection rates and community transmission
Patient Discharge Instructions
copy discharge instructions
Urethritis Discharge Instructions
Your diagnosis and treatment
You were diagnosed with urethritis (inflammation of the urethra), likely caused by a sexually transmitted infection
You received antibiotic treatment today — complete the full course even if symptoms improve
Your medications
Take all prescribed antibiotics as directed — do not skip doses
Doxycycline: take with a full glass of water and remain upright for 30 minutes to prevent esophageal irritation
Avoid alcohol while taking metronidazole (tinidazole) — can cause severe nausea and flushing
Sexual activity restrictions
Abstain from all sexual intercourse for 7 days after single-dose treatment OR until you have finished a 7-day course AND symptoms have resolved AND your partner has been treated
Using condoms consistently reduces risk of reinfection
Partner notification
Your sexual partners from the last 60 days need to be tested and treated
Your doctor may be able to provide medication for your partner (expedited partner therapy) without them needing to come in
Follow-up testing
Return for repeat STI testing in 3 months (this is to check for reinfection, not treatment failure)
Do not get retested sooner than 3 weeks after treatment — early testing may give a false-positive result
Public health reporting
Gonorrhea and chlamydia are reportable conditions — your healthcare provider is required by law to notify public health authorities (your name is kept confidential)
Return to the emergency department immediately for
Testicular pain or swelling
Fever, joint pain, or joint swelling
Skin rash or unusual skin spots
Eye redness or discharge
Symptoms not improving after 48 to 72 hours of treatment
Inability to take your medications
Expected recovery
Symptoms typically improve within 48 to 72 hours of appropriate antibiotic therapy
If symptoms worsen or do not improve, return for reassessment — resistant organisms or alternative diagnoses may need consideration
References
Guidelines and key sources
CDC 2021 STI Treatment Guidelines
Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep. 2021
Primary reference for all treatment regimens and diagnostic criteria
Covers gonorrhea, chlamydia, M. genitalium, T. vaginalis, and partner management
Key guideline changes: doxycycline preferred for chlamydia; azithromycin combination removed for gonorrhea
Yonke N, Aragón M, Phillips JK. Chlamydial and Gonococcal Infections: Screening, Diagnosis, and Treatment. American Family Physician. 2022
Screening recommendations and treatment algorithms
PMID: 35426632
Emerging and Reemerging STIs
Williamson DA, Chen MY. Emerging and Reemerging Sexually Transmitted Infections. NEJM. 2020
M. genitalium resistance patterns and emerging management strategies
PMID: 32187466
IDSA/ASM Microbiology Laboratory Guidance 2024
Miller JM, Binnicker MJ, Campbell S, et al. Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2024 Update. CID. 2024
NAAT performance characteristics and specimen collection guidance
DOI: 10.1093/cid/ciae104
AFP STI Updates from 2021 CDC Guidelines
Dalby J, Stoner BP. Sexually Transmitted Infections: Updates From the 2021 CDC Guidelines. American Family Physician. 2022
Summary of key changes in 2021 CDC guidelines
PMID: 35559639
Gonorrhea Treatment Recommendations
Barbee LA, St Cyr SB. Management of Neisseria Gonorrhoeae in the United States. CID. 2022
Evidence base for 2020 gonorrhea treatment recommendations
PMID: 35416971
Dysuria Evaluation and Differential Diagnosis
Hoffman A, Dolezal KA, Powell R. Dysuria: Evaluation and Differential Diagnosis in Adults. American Family Physician. 2025
Differential diagnosis framework for dysuria including urethritis
PMID: 39823614
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.