Background Non gonococcal urethritis (NGU) is thought to be most often due to Chlamydia trachomatis (CT), Mycoplasma genitalium (MG) and Ureaplasma urealyticum. Standard doses of Azithromycin 1g stat may be insufficient to clear MG and may induce resistance to macrolides while doxycycline is not sufficient to clear MG. Doxycycline has been advocated as first line therapy for NGU allowing extended dosage with Azithromycin in those that do not clear with first line therapies.

Aim To look at the current pathways for managing NGU and assess how often patients who have first line Doxycycline return for further therapy.

Methods A retrospective review of all patients initially treated for NGU in August and September 2015 across a sexual health trust.

Results Of the 208 cases reviewed, 26.4% were due to CT. 99.5% of all cases were treated with a first line antibiotic; with 95.2% receiving Doxycycline 100mg bd for 7 days compared to 4.3% receiving Azithromycin 1g stat. In both the CT and non-CT groups 9%, returned within 90 days after experiencing symptoms despite treatment. Of these, only 15.8% were diagnosed with persistent NGU and treated with extended Azithromycin.

Conclusion Current pathways designed to preserve macrolide therapy using Doxycycline initially result in few patients reattending with persistent symptoms than would be anticipated. The impact of Doxycycline on reducing MG load and related symptoms should be factored into advice given to patients who may dismiss mild symptoms or be reassured by negative CT/NG NAATs often communicated to them by text.