The feasibility of empirical antibacterial therapy for infectious urethritis in men: expert opinion of a dermatovenerologist and a medical lawyer

Khryanin A.A., Radchenko M.V.

1) Novosibirsk State Medical University, Novosibirsk, Russia; 2) Regional Public Organization «Association of Obstetricians-Gynecologists and Dermatovenerologists», Novosibirsk, Russia; 3) South Ural State University, Chelyabinsk, Russia; 4) South Ural State Medical University, Chelyabinsk, Russia

Infectious urethritis in men (inflammation of the urethra) is caused by various sexually transmitted infections (STIs), most commonly bacteria such as Chlamydia trachomatis, Neisseria gonorrhoeae, or Mycoplasma genitalium. In clinical practice, empirical antibiotic therapy is often prescribed for suspected infectious urethritis even before laboratory diagnostic results confirm the presence of the pathogen. Given the global increase in antibiotic resistance among STIs, it is important to consider the epidemiology of pathogens, their drug susceptibility, and possible concomitant infections. Laboratory diagnostics for suspected infectious urethritis include: if urethral discharge is present, taking a urethral swab for microscopic examination, bacteriological culture, and determination of the antibiotic susceptibility of N. gonorrhoeae; regardless of the presence of discharge, performing nucleic acid amplification testing to detect STIs (e.g., N. gonorrhoeae, C. trachomatis, and M. genitalium) in a urethral swab. The decision to initiate empirical antibiotic therapy for urethritis should be individualized, taking into account specific criteria for the patient: symptom severity, risk of complications, epidemiological data, etc. If gonococcal urethritis is suspected, ceftriaxone is recommended. If nongonococcal urethritis is suspected, doxycycline and josamycin are recommended for empirical treatment. This analytical review provides detailed recommendations for empirical antibiotic therapy for infectious urethritis. The authors analyze the main criteria indicating the appropriateness or inadvisability of empirical antibiotic therapy.

For citations: Khryanin A.A., Radchenko M.V. The feasibility of empirical antibacterial therapy for infectious urethritis in men: expert opinion of a dermatovenerologist and a medical lawyer. Pharmateca. 2026;33(5):32-40. (In Russ.). DOI: https://dx.doi.org/10.18565/pharmateca.2026.5.32-40

Authors’ contribution: All authors bear equal responsibility for the content and integrity of the entire article. Concept development, writing and editing, and approval of the final version – A.A. Khryanin, M.V. Radchenko.
Conflicts of interest: The authors confirm that they have no conflicts of interest to declare.
Funding: The authors have no financial interest in the materials or methods presented.

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About the Authors

Aleksey A. Khryanin, Dr. Sci. (Med.), Professor, Department of Dermatovenereology and Cosmetology, Novosibirsk State Medical University; President of the Association of Obstetricians-Gynecologists and Dermatovenereologists, Novosibirsk; Healthcare Quality Expert, TCMIF, Novosibirsk, Russia; khryanin@mail.ru, ORCID: https://orcid.org/0000-0001-9248-8303 (corresponding author)
Margarita V. Radchenko, Cand. Sci. (Jurisprudence), Associate Professor, Department of Civil Law and Civil Procedure, Law Institute, South Ural State University; Associate Professor, Department of Public Health and Healthcare, Institute of Continuous Professional Education, South Ural State Medical University, Chelyabinsk, Russia; mamarad@mail.ru, ORCID: https://orcid.org/0009-0001-2711-0870

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