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Urethral Discharge (Urethritis)
🧠 Think pattern-recognition: purulent + rapid onset → gonorrhoea more likely 🟡. scant/clear + dysuria → often NGU (e.g., chlamydia) 🧫. Always ask about oral/anal sex because pharyngeal/rectal infection can be silent.
🦠 Causes
- Chlamydia trachomatis 🧫 - commonest cause of non-gonococcal urethritis (NGU).
- Neisseria gonorrhoeae 🟡 - purulent discharge, dysuria; can be asymptomatic at extragenital sites.
- Mycoplasma genitalium 🧬 - important in persistent/recurrent NGU (resistance matters).
- Trichomonas vaginalis 🧪 - consider in persistent symptoms or high-prevalence settings.
- Non-infectious 🔥 - trauma/irritants, urethral instrumentation, prostatitis, reactive inflammation.
🔍 Clinical Tests
- NAAT ✅ (first-void urine) for chlamydia + gonorrhoea (gold standard).
- Culture 🧫 (especially if suspected gonorrhoea) to guide antibiotics/sensitivity.
- Microscopy 🔬 if available (PMNs; GNID suggests gonorrhoea).
- Extragenital testing 🎯 (pharyngeal/rectal) based on exposure.
- BBV screen 🩸 - HIV + syphilis (and hepatitis depending on risk).
💊 Treatment (UK-focused)
- Chlamydia: doxycycline 100 mg BD for 7 days (pregnancy: follow local guidance).
- Gonorrhoea: ceftriaxone IM single dose (dose per current UK guidance) ± chlamydia cover if not excluded.
- M. genitalium: specialist/sexual health regimen (often resistance-guided).
- Trichomoniasis: metronidazole regimen (per guidance).
- Partner notification 🤝 and treat partners to prevent reinfection.
- Abstain from sex 🚫 until treatment is complete and partners treated.
⚠️ Don’t miss complications: epididymo-orchitis, prostatitis, PID in partners, and disseminated gonococcal infection (rash/arthritis).
| The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms. |
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