Urethritis

The US Centers for Disease Control and Prevention (CDC) recommends that a test of cure is not needed for people who receive a diagnosis of uncomplicated urogenital gonorrhoea who are treated with any of the recommended or alternative regimens.[1]Centers for Disease Control and Prevention. Sexually transmitted infections treatment guidelines, 2021. Jul 2021 [internet publication]. https://www.cdc.gov/std/treatment-guidelines/default.htm ​ Patients who are given a specific diagnosis of chlamydia, gonorrhoea, or trichomonas should be re-tested 3 months after treatment, as rates of re-infection are reported to be high, regardless of whether their sex partners were treated. Pregnant women should be re-tested to ensure cure, preferably with a nucleic acid amplification test (NAAT) such as ligase chain reaction or polymerase chain reaction of urethral discharge and/or urine sediment. Chlamydia test of cure is recommended 4 weeks after treatment, with a re-test at 3 months. Re-test for gonorrhoea is recommended at 3 months.[1]Centers for Disease Control and Prevention. Sexually transmitted infections treatment guidelines, 2021. Jul 2021 [internet publication]. https://www.cdc.gov/std/treatment-guidelines/default.htm

In presence of recurrent or persistent urethritis, objective signs should be documented because symptoms alone should not warrant retreatment. Patients may be retreated with their initial regimen if they did not complete it or they were exposed to an untreated sex partner. Treatment failure should be considered in patients whose symptoms do not resolve in 3 to 5 days after appropriate treatment and who report no sexual contact during the post-treatment period, and in patients with a positive test of cure (i.e., positive culture >72 hours or NAAT >7 days after receiving recommended treatment) and who report no sexual contact during the post-treatment period. Treatment failures should prompt consultation with an infectious disease specialist and in many countries such cases should be reported to government health authorities.[1]Centers for Disease Control and Prevention. Sexually transmitted infections treatment guidelines, 2021. Jul 2021 [internet publication]. https://www.cdc.gov/std/treatment-guidelines/default.htm As a last step for refractory cases, rare causes such as herpetic urethritis should be ruled out.