Urethral Discharge In Men

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The commonest causes are Neisseria gonorrhoeae and Chlamydia trachomatis, and the two often co-exist. Trichomonas vaginalis also causes a urethral discharge in men. All males with urethral discharge and all women with cervicitis should be treated for both gonorrhoea and chlamydia in view of the fact that the two coexist and present with similar signs and symptoms. Any sex partners in the preceding three months should be treated presumptively for the same infections as in the index patient, and any other conditions found on examination Recent studies (2015) from Zimbabwe showed that a small proportion of men with urethral discharge have Mycoplasma genitalium.

First Line:

Medicine

Adult dose

Frequency / Duration

ceftriaxone im

250mg

one dose only

or

kanamycin im

2g (1g in each buttock)

one dose only

and

doxycycline po

100mg

twice a day for 7 days

or

azithromycin po 

1g

one dose only

If the patient still has a urethral discharge, or evidence of urethritis 7 days after start of treatment, suspect re-infection, poor treatment compliance or antimicrobial resistance in Neisseria gonorrhoeae. If re-infection is suspected re-start first line treatment.

Otherwise treat the patient with second line therapy or refer for investigations and laboratory guided treatment.

Second Line:

Medicine

Adult dose

Frequency / Duration

ceftriaxone im

500mg

one dose only

or

cefixime po

400mg

one dose only

and

metronidazole po

2g

one dose only

and

doxycycline po (Dependent on 1st line Rx* if 1st line Azithromycin)

100mg

twice a day for 7 days

or

azithromycin po (if 1st line doxycycline)

1g stat than 500mg od for 2 days

3 days

*New evidence suggests this approach which is updated from Zimbabwe STI guidelines

  • If these medicines are not available locally, refer to the next level.