STI-related Urethral Discharge in Males
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Causes
Neisseria gonorrhoea (Gonococcal urethrits)
Chlamydia trachomatis (Non-gonococcal urethritis)
Mycoplasma genitalum
Symptoms
- Urethral discharge
- Dysuria or discomfort on urination
Signs
- Urethral discharge
Note: Gentle milking of the urethra may reveal the discharge if it is not initially visible. In uncircumcised males, check that the discharge is coming from the urethral opening and not from the glans penis.
Investigations
- Urethral swab culture and sensitivity (if available)
TreatmentTreatment Objectives
- To treat gonorrhoea and chlamydia urethritis simultaneously
- To prevent further 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
- Ceftriaxone, IM, 250 mg stat
Or
- Cefixime, oral, 400 mg stat
Or
- Ciprofloxacin, oral, 500 mg stat
AND
For Chlamydia and Mycoplasma:
- Doxycycline, oral, 100 mg 12 hourly for 7 days
Or
- Tetracycline, oral, 500 mg 6 hourly for 7 days
Or
- Erythromycin, oral, 500 mg 6 hourly for 7 days
Or
- Azithromycin, oral, 1 g stat.