Sexual Health STDs More STDs Non-Gonoccocal Urethritis (NGU) Treatment By Elizabeth Boskey, PhD facebook twitter linkedin Elizabeth Boskey, PhD, MPH, CHES, is a social worker, adjunct lecturer, and expert writer in the field of sexually transmitted diseases. Learn about our editorial process Elizabeth Boskey, PhD Medically reviewed by Medically reviewed by Anita Sadaty, MD on January 19, 2020 facebook twitter linkedin instagram Anita Sadaty, MD, is a board-certified obstetrician-gynecologist at North Shore University Hospital and founder of Redefining Health Medical. Learn about our Medical Review Board Anita Sadaty, MD on January 19, 2020 Print Most cases of Non-Gonococcal Urethritis (NGU) are undiagnosed chlamydia infections. Therefore, the first line of treatment for NGU is the same as the treatment for chlamydia. If that NGU treatment doesn’t work, and you took all your medication as instructed, your doctors need to investigate further. The next step is usually for them to check you for a trichomoniasis infection. If that test is negative, you may not get a clear answer. (Often NGU is caused by mycoplasma, but that is only rarely tested for.) If your doctor can’t identify what the source of the infection is, they will generally treat you with one of the drugs below. This is because some of the bacteria that cause urethritis can be difficult to identify. Therefore, treating NGU this way is an effective way to eliminate the most common suspects. Note: The drug regimens below are taken from the Centers for Disease Control 2015 STD treatment guidelines. Remember that only your doctor can say which treatment is right for you. Smith Collection / Gado / Getty Images Initial Treatment One of the following treatments is typically used for initial treatment of infection: Azithromycin 1 g orally in a single doseDoxycycline 100 mg orally twice a day for 7 days Alternative treatment regimens include one of the following: Erythromycin base 500 mg orally four times a day for 7 daysErythromycin ethylsuccinate 800 mg orally four times a day for 7 daysLevofloxacin 500 mg orally once daily for 7 daysOfloxacin 300 mg orally twice a day for 7 days Sometimes these treatments are ineffective. That is often because the infection is caused by a fungal or parasitic infection, such as trichomoniasis. (Sometimes the parasitic infection is in addition to a bacterial infection!) Therefore, if the initial treatment fails, doctors will try other options. When Initial Treatment Isn't Successful One of the following medications can be used if initial treatment is not successful: Metronidazole 2 g orally in a single doseTinidazole 2 g orally in a single doseAzithromycin 1 g orally in a single dose (if not used for initial treatment)Moxifloxacin 400 mg orally once daily for 7 days (if azithromycin was used for initial treatment) The azithromycin and moxifloxacin are used because they are more likely to be effective against mycoplasma than some other medications. The moxifloxacin, in particular, is a relatively new recommendation. By the time the 2015 treatment recommendations were released, mycoplasma were considered to be a major cause of NGU. Therefore, aiming treatment at mycoplasma was thought to be important after an initial treatment failure. However, the CDC has found that higher dose azithromycin is not helpful in treating mycoplasma. That's why they recommend moxifloxacin rather than a second round of azithromycin treatment for NGU. In contrast, metronidazole and tinidazole are used to treat possible trichomoniasis infections. Testing is not universally available for this infection in men. Additional Treatment Notes You should generally stop having sex while on treatment. This reduces the likelihood that you and your partner will pass an infection back and forth. Any regular sexual partner should also be referred for testing and treatment when you are diagnosed with an STD. Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Cleveland Clinic. Nongonococcal urethritis in men. Updated March 1, 2017. Moi H, Blee K, Horner PJ. Management of non-gonococcal urethritis. BMC Infect Dis. 2015;15:294. doi:10.1186/s12879-015-1043-4 Brill JR. Diagnosis and treatment of urethritis in men. Am Fam Physician. 2010;81(7):873-878. Workowski KA, Bolan GA. Sexually transmitted diseases treatment guidelines, 2015. Centers for Disease Control and Prevention. Updated June 5, 2015. Bradshaw CS, Jensen JS, Waites KB. New horizons in mycoplasma genitalium treatment. J Infect Dis. 2017;216:S412-S419. doi:10.1093/infdis/jix132