Sunday, October 30, 2011

Urethral Discharge: Is it Urethritis?

Urethritis is typically a sexually transmitted infection, but not always. It can be divided into gonococcal urethritis (GU) and non-gonococcal urethritis (NGU).

Gonoccal urethritis is caused by the bacteria Neiserria gonorrhea, while NGU can be caused by other bacterias include Chlamydia, Ureaplasma, Mycoplasma and even syphilis etc.




Both GU and NGU usually produce similar symptoms, though some infected people does not have any complains. The most common symptoms are:
  • urethral /vaginal discharge
  • urethral/ vaginal itchiness / pain
  • dysuria (pain when passing urine)

Due to certain sexual practice, patients may also have symptoms (pain and discharge) at the pharynx, anus or rectum.

Sometimes the infection may spread to the adjacent organs such as bladder (cystitis), testis (orchitis), epididymis (epididymitis), cervix (cervicitis), ovary (oophroritis) etc.

     Urethral discharge from tip of penis

Useful investigation:
  • urethral discharge swab
    • gram stain (GU - intracellular gram negative diplococci)
    • culture & sensitivity (modified Thayer Martin culture)
    • nucleic acid amplification test (NAAT)
  • urine
    • FEME/culture (not very useful)

Treatment (CDC 2010 guidelines):

Since GU and NGU commonly co-exist. It is preferable to cover both condition when treatment for urethritis is give.

Uncomplicated GU
  • IM ceftriaxone 250mg single dose OR
  • T cefixime 400mg single dose OR
  • T cefuroxime 1g single dose
Plus (for NGU)
  • T azithromycin 1g single dose OR
  • T doxycycline 100mg bd for 7 days

Contact tracing should be done. Those who has recent sexual contact with patients should be treated, even if they are asymptomatic.

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