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Urethral discharge


Any inflammatory condition within the urethra may cause a discharge. It is important to diagnose sexually transmitted diseases so that appropriate treatment is given, not only to the patient but also to sexual contacts via contract tracing.

Causes

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    Prostatitis

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    Non-gonococcal urethritis

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      Chlamydia trachmatis

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      UTI

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      HSV

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      Adenovirus

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      Trichomonas vaginalis

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      Mycoplasma genitalium

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    Gonococcal urethritis

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    Rare causes

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      Coliforms

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      Haemophilus ducreyi (chancroid)

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      TB

    • ●

      Syphilis (chancre)

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    Reiter’s disease

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    Traumatic

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      Instrumental

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      Accidental

    • ●

      Foreign body

  • ●

    Chemical (e.g. soaps)

  • ●

    Neoplastic

History

General

For any sexually transmitted disease, check for a history of sexual contact, time of last sexual intercourse, contraceptive methods, number and duration of relationships, sexual practices and unusual sexual practices.

Prostatitis

Urethral discharge is rare with acute prostatitis, but with chronic prostatitis, there may be a clear white urethral discharge. The patient may also complain of suprapubic pain, low back pain, perineal discomfort and pain referred to the testicles.

Non-gonococcal urethritis

The patient complains of urethral discharge, which may be thinner than with gonorrhoea. The presentation may be less acute than with gonorrhoea. Chlamydia is one of the most common causes and often asymptomatic in a large proportion of patients. If symptoms are present, they include a clear discharge, pain or burning sensation during micturition. Similar symptoms are found in mycoplasma but patients often report more symptoms. In UTI, there will also be a history of increased frequency with lower abdominal pain. A history of cold sores may be apparent as well as a tingling, burning or pain when passing urine in HSV. Adenovirus usually has a history of a flu-like symptoms, whilst in trichomonas vaginalis there is a yellow/green frothy discharge.

Gonococcal urethritis

The patient will complain of a thickish, purulent urethral discharge and dysuria. Prostatitis and epididymitis may occur, the patient complaining of deep perineal pain or scrotal swelling.

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