STI-Related Persistent or Recurrent Urethral Discharge

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This may occur due to drug resistance, poor treatment compliance or re-infection following treatment for an STI. In some cases persistence of urethral discharge may be due to infection with Trichomonas vaginalis.

Cause

  • Neisseria  gonorrhoeae, Chlamydia trachomatis or Mycoplasma genitalum following drug resistance, poor compliance or re-infection after treatment
  • Trichomonas vaginalis

TreatmentTreatment Objectives

  • To re-treat for gonococcal or non-gonococcal urethritis if suspected to be due to previous poor treatment compliance or re-infection
  • To treat infection with Trichomonas vaginalis
  • To prevent transmission to sexual partners
  • To treat both partners simultaneously as much as possible
  • To prevent development of complications and sequelae
  • To reduce risk of HIV infection

Non-pharmacological treatment

  • None

Pharmacological Treatment

Evidence Rating: [C]

For Gonorrhoea, Chlamydia, Mycoplasma

Repeat treatment for urethral discharge 

For Trichomonas vaginalis

  • Metronidazole, oral, 400 mg 12 hourly for 7 days

Or

  • Metronidazole, oral, 2 g stat.

Or

  • Tinidazole, oral, 2 g stat.

Or 

  • Secnidazole, oral, 2 g stat. 

Referral Criteria

  • Refer all cases of treatment failure to a health facility where microbiological culture and antimicrobial sensitivity tests can be done on the urethral discharge.