Macrolide and quinolone-resistant in a man with persistent urethritis: the tip of the British iceberg?

There is growing concern worldwide for macrolide resistance in following liberal use of 1 g azithromycin to treat non-gonococcal urethritis and confirmed infection. Moxifloxacin is the second-line treatment for and still has excellent efficacy against it. However, recent reports indicating that quinolone resistance is more prevalent than previously thought are worrying. Routine testing of symptomatic men and women for is not currently recommended in BASHH guidelines, and attempts to implement such testing have been hampered by a lack of commercially available assays. We present a case of urethritis which failed to respond to four different antibiotic regimens, resulting in multiple visits to the clinic and anxiety for the patient.