title: 2016 European guideline on the management of non-gonococcal urethritis.
abstract: We present the updated International Union against Sexually Transmitted Infections (IUSTI) guideline for the management of non-gonococcal urethritis in men. This guideline recommends confirmation of urethritis in symptomatic men before starting treatment. It does not recommend testing asymptomatic men for the presence of urethritis. All men with urethritis should be tested for Chlamydia trachomatis and Neisseria gonorrhoeae and ideally Mycoplasma genitalium using a nucleic acid amplification test (NAAT) as this is highly likely to improve clinical outcomes. If a NAAT is positive for gonorrhoea, a culture should be performed before treatment. In view of the increasing evidence that azithromycin 1 g may result in the development of antimicrobial resistance in M. genitalium, azithromycin 1 g is no longer recommended as first line therapy, which should be doxycycline 100 mg bd for seven days. If azithromycin is to be prescribed an extended course of 500 mg stat, then 250 mg daily for four days is to be preferred over 1 g stat. In men with persistent NGU, M. genitalium NAAT testing is recommended if not previously undertaken, as is Trichomonas vaginalis NAAT testing in populations where T. vaginalis is detectable in >2% of symptomatic women.
authors.affiliation: School of Social and Community Medicine, University of Bristol, UK Bristol Sexual Health Centre, University Hospitals Bristol NHS Foundation Trust, UK paddy.horner@bristol.ac.uk.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Horner
authors.affiliation: Bristol Sexual Health Centre, University Hospitals Bristol NHS Foundation Trust, UK.
authors.forename: Karla
authors.initials: K
authors.lastname: Blee
authors.affiliation: Department of Dermatology and Venereology, Linköping University Hospital, Sweden Department of Clinical and Experimental Medicine, Linköping University, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Falk
authors.affiliation: Department of Dermatology, New Cross Hospital, UK.
authors.forename: Willem
authors.initials: W
authors.lastname: van der Meijden
authors.affiliation: Olafia Clinic, Oslo University Hospital, Institute of Medicine, University of Oslo, Norway.
authors.forename: Harald
authors.initials: H
authors.lastname: Moi
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017963:Azithromycin / Q000627:therapeutic use; D002692:Chlamydia trachomatis / Q000302:isolation & purification; D004318:Doxycycline / Q000627:therapeutic use; D024881:Drug Resistance, Bacterial; D024841:Fluoroquinolones / Q000627:therapeutic use; D017408:Guidelines as Topic; D006801:Humans; D008795:Metronidazole / Q000627:therapeutic use; D000077266:Moxifloxacin; D045704:Mycoplasma genitalium / Q000302:isolation & purification; D014526:Urethritis / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D008795:Metronidazole; D017963:Azithromycin; D004318:Doxycycline; D000077266:Moxifloxacin
keywords: Chlamydia (Chlamydia trachomatis); guideline; non-gonococcal urethritis; treatment