LAUSR

BACKGROUND Standard counseling at nongonococcal urethritis (NGU) diagnosis includes advice to abstain from sex for ≥7 days and until symptoms resolve. METHODS From 12/2014 to 07/2018, we enrolled men who have sex with men and received azithromycin (1g) for NGU at the Public Health-Seattle and King County STD Clinic. Over 12 weeks of follow-up, participants reported daily urethral symptoms and sexual activity on web-based diaries. NGU was defined as urethral symptoms or visible urethral discharge plus ≥5 polymorphonuclear leukocytes per high-power field. Time of symptom resolution was defined as the first of five consecutive asymptomatic days. RESULTS Of 100 participants with NGU and no Chlamydia trachomatis (CT)/Mycoplasma genitalium (MG) co-infections, 36 (36%), 22 (22%), and 42 (42%) had CT-NGU, MG-NGU, and non-CT/non-MG NGU, respectively. Among men with MG-NGU, 94% had a macrolide resistance mutation. For all etiologies, median time to symptom resolution after azithromycin was seven days (95% confidence interval [CI]=5-9); 37% had symptoms lasting >7 days. For men with CT-NGU, MG-NGU, and non-CT/non-MG NGU, median time to symptom resolution was four (95%CI=2-6, 16% >7 days), undefined (95%CI=7-undefined, 60% >7 days), and seven (95%CI=5-11, 46% >7 days) days, respectively. Median time to first sexual activity (any type) was 12 days (95%CI=11-17); it was 16 days (95%CI=12-18) to first urethral sexual exposure. Twenty-seven percent did not avoid urethral exposure for the recommended period. CONCLUSIONS Counseling at NGU diagnosis should educate patients that symptoms may persist >7 days, particularly for non-CT NGU, and emphasize the rationale for the 7-day abstinence period.