Urethral Discharge Syndrome (Male)
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It refers to urethral discharge in men with or without dysuria, caused by a number of diseases usually spread by sexual intercourse, which produce similar manifestations in males and may be difficult to distinguish clinically.
Causes
- Common: Neisseria gonorrhoea (causing gonorrhoea), Chlamydia trachomatis and Ureaplasma urealyticum
- Uncommon: Trichomonas vaginalis
Clinical features
- Mucus or pus at the tip of the penis; staining underwear
- Burning pain on passing urine (dysuria), frequent urination
Investigations
- Pus swab: Gram stain, culture and sensitivity
- Blood: Screen for syphilis and HIV
- Examine patient carefully to confirm discharge
Management
Treatment
- Take history and examine the client. Milk urethra if discharge is not obvious
- Retract prepuce and examine for ulcers
- Treat both patient and sexual partners
- Advise abstinence or condom use
Medicines
- Ceftriaxone 250 mg IM or Cefixime 400 mg single dose plus
- Doxycycline 100 mg every 12 hours for 7 days
If partner is pregnant
- Substitute doxycycline with erythromycin 500 mg every 6 hours for 7 days
- or Azithromycin 1 g stat if available
If discharge or dysuria persists and partners were treated:
- Exclude presence of ulcers under prepuce
- Repeat doxycycline 100 mg every 12 hours for 7 days
- Also give metronidazole 2 g single dose
If discharge or dysuria persists and partners were not treated:
- Start the initial treatment all over again and treat partners
If discharge persists still
- Ceftriaxone 1 g IM
- Refer for specialist management if not better