URETHRAL DISCHARGE SYNDROME (MEN)

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

  • 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 500mg 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 dicharge persists still

  • Ceftriaxone 1 g IM
  • Refer for specialist management if not better