Dawaa Reference

infectious

Male Urethritis (Acute)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources5 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 against6 documents
  • 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

Verified date2026-08

Presentation reference

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

SourceStatPearls "Urethritis" - disease-level clinical article

Presentation findings are traced to the source above.

Combination safety

Combination regimens

!! 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

Regimen: urethritis-empiric

1 of 2 - GIVE ALL TOGETHER

Strength500 mg

Forminjection

Adult dose and duration

500 mg IM single dose PLUS Doxycycline 100 mg BID for 7 days for empiric treatment of acute male urethritis - single IM dose

Paediatric dose

Specialist pediatric adolescent medicine referral

AWaRe

WATCH group - carries resistance cost. Egyptian EML 2025.

Dose 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.

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
TRIXOMASH 500MG VIAL FOR I.V. INJ.RAMEDA > MASH PREMIERE16.50 EGP
WINTRIAXONE 500 MG PD. FOR I.V INJ.SANOFI21.75 EGP
CEFAXONE 500MG I.V. VIALPHARCO B25.25 EGP
TRIAXONE 500MG VIAL FOR I.M. INJ.TABUK PHARMACEUTICAL MANUFACTURING COMPANY > TABUK PHARMA36.00 EGP
TRIAMERICAN 500 MG I.M. VIALRAMEDA > PAXAL46.00 EGP
EPICEPHIN 500 MG I.V. VIALEIPICO47.00 EGP
CEFAXOTREZ 500 MG I.M. VIALRAMEDA > BOSTON CARE PHARMACEUTICALS63.00 EGP
CEFAXOTREZ 500 MG I.V. VIALRAMEDA > BOSTON CARE PHARMACEUTICALS63.00 EGP
2

DOXYCYCLINE

Regimen: urethritis-empiric

2 of 2 - GIVE ALL TOGETHER

Strength100 mg

Formoral.solid

Adult dose and duration

100 mg twice daily for 7 days co-administered with Ceftriaxone for Chlamydia coverage x 7 days

Paediatric dose

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.

Dose 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.

Cautions
  • Advise completing full 7-day course even if discharge resolves.
  • Abstain from sexual contact until 7 days after starting treatment and symptoms resolve.
Egyptian brands
Egyptian brandManufacturerIndicative price
FARCODOXIN 100MG 10 CAPS.PHARCO11.00 EGP (1.10/unit)
DOXY M.R.100 MG 10 CAPS.ADWIA12.00 EGP (1.20/unit)
GRANUDOXY 100MG 10 F.C. TAB.GLOBAL NAPI PHARMACEUTICALS > PIERRE FRANCE12.00 EGP (1.20/unit)
DOXYDOX 100 MG 10 CAPS.EIPICO23.00 EGP (2.30/unit)
DOXYMYCIN 100 MG 10 CAPS.EL NILE.30.00 EGP (3.00/unit)
TABOCINE 100MG 10 CAPS.TABUK PHARMACEUTICAL MANUFACTURING COMPANY > TABUK PHARMA46.00 EGP (4.60/unit)
VIBRAMYCIN 100MG 10 CAPS.PFIZER65.00 EGP (6.50/unit)
3

AZITHROMYCIN

2nd line

Strength1000 mg

Formoral.solid

Adult dose and duration

1 g single oral dose (alternative when doxycycline is contraindicated or compliance is doubtful) - single dose

Paediatric dose

Specialist use only

AWaRe

WATCH group - carries resistance cost. Egyptian EML 2025.

Dose 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.

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
AZIROWA 1000 MG 2 F.C. TABS.AL ROWAD PHARMACEUTICAL INDUSTRIAL CO.44.00 EGP (22.00/unit)
ZITHRODOSE 100MG/5ML SUSP. 15ML? strength differs? different route - not oral solidEL-OBOUR > AVERROES PHARMA-EGYPT12.00 EGP
ZITHROPHATE 200MG/5ML SUSP. 15ML? strength differs? different route - not oral solidORGANO PHARMA > NOVELL PHARMA12.75 EGP

TRICHOMONAL URETHRITIS - INDEX CASE AND SEX PARTNER

4

METRONIDAZOLE

Trichomonal urethritis - index case and sex partner

2nd line

Strength500 mg

Formoral.solid

Adult dose and duration

500 mg twice daily x 7 days

Paediatric dose

Not applicable - a sexually transmitted infection in adult men.

Dose 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.

Cautions
  • 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
Egyptian brands
Egyptian brandManufacturerIndicative price
DUMOZOL 500MG 20 F.C. TABS.MINA PHARM > ALPHARMA-DENMARK7.00 EGP (0.35/unit)
ZOLGUARD 500MG 20 TAB.UNIPHARMA CO. > UNIPHARMA9.00 EGP (0.45/unit)
NITROFECTAZOLE 500 MG 20 F.C. TABS.GYPTO PHARMA10.50 EGP (0.53/unit)
FLAGICURE FORTE 500 MG 20 F.C. TABKAHIRA23.00 EGP (1.15/unit)
TRICHOGYL 500MG 12 F.C.TAB.EL NASR15.00 EGP (1.25/unit)
FLAGELLAT FORTE 500MG 20 F.C.TABS.MUP30.00 EGP (1.50/unit)
GEDAZOLE 500MG 20 TAB.JEDCO INT. CO. FOR PHARMACEUTICALS34.00 EGP (1.70/unit)
METROGYPTON 500 MG 20 F.C. TABS.GYPTO PHARMA34.00 EGP (1.70/unit)
DUMOZOL 125MG/5ML SUSP. 125ML? strength differs? different route - not oral solidMINA PHARM > ALPHARMA-DENMARK5.75 EGP
METROZOLE 125MG/5ML SUSP. 120 ML? strength differs? different route - not oral solidMEMPHIS19.50 EGP

ORAL CEPHALOSPORIN - ALTERNATIVE GONOCOCCAL REGIMEN WHEN IM CEFTRIAXONE IS UNAVAILABLE

5

CEFIXIME

Oral cephalosporin - alternative gonococcal regimen when IM ceftriaxone is unavailable

2nd line

Strength400 mg

Formoral.solid

Adult dose and duration

800 mg orally as a single dose - Single dose

Paediatric dose

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.)

Dose by weight
3kg24 mg/day
4kg32 mg/day
5kg40 mg/day
6kg48 mg/day
7kg56 mg/day
8kg64 mg/day
9kg72 mg/day
10kg80 mg/day
11kg88 mg/day
12kg96 mg/day
13kg104 mg/day
14kg112 mg/day
15kg120 mg/day
16kg128 mg/day
17kg136 mg/day
18kg144 mg/day
19kg152 mg/day
20kg160 mg/day
21kg168 mg/day
22kg176 mg/day
23kg184 mg/day
24kg192 mg/day
25kg200 mg/day
26kg208 mg/day
27kg216 mg/day
28kg224 mg/day
29kg232 mg/day
30kg240 mg/day
31kg248 mg/day
32kg256 mg/day
33kg264 mg/day
34kg272 mg/day
35kg280 mg/day
36kg288 mg/day
37kg296 mg/day
38kg304 mg/day
39kg312 mg/day
40kg320 mg/day
41kg328 mg/day
42kg336 mg/day
43kg344 mg/day
44kg352 mg/day
45kg360 mg/day
46kg368 mg/day
47kg376 mg/day
48kg384 mg/day
49kg392 mg/day
50kg400 mg/day
AWaRe

WATCH group - carries resistance cost. Egyptian EML 2025.

Dose 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.

Cautions
  • 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
Egyptian brands
Egyptian brandManufacturerIndicative price
HEBIXIME 400MG 5 CAPS.SHIFA MEDICAL PRODUCTS > GLORY MEDICAL60.00 EGP (12.00/unit)
XIMACEF 400MG 5 CAPSULESIGMA63.00 EGP (12.60/unit)
WIDEPREX 400 MG 5 CAPS.BIOMED PHARMACEUTICALS104.00 EGP (20.80/unit)
SUPRAX 400 MG 5 CAPS.KAHIRA > HIKMA PHARMA159.00 EGP (31.80/unit)
VIODRILNEX 100MG/5ML SUSP. 30ML? strength differs? different route - not oral solidBADR PHARMA > HOCHSTER PHARMACEUTICAL INDUSTRIES21.50 EGP
CEFABRUM 100MG/5ML SUSP. 60ML? strength differs? different route - not oral solidALFACURE PHARMACEUTICALS27.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.