Urethral Discharge (Urethritis)
๐ง Think pattern-recognition: purulent + rapid onset โ gonorrhoea more likely ๐ก.
scant/clear + dysuria โ often NGU (e.g., chlamydia) ๐งซ.
Always ask about oral/anal sex because pharyngeal/rectal infection can be silent.
๐ฆ Causes
- Chlamydia trachomatis ๐งซ โ commonest cause of non-gonococcal urethritis (NGU).
- Neisseria gonorrhoeae ๐ก โ purulent discharge, dysuria; can be asymptomatic at extragenital sites.
- Mycoplasma genitalium ๐งฌ โ important in persistent/recurrent NGU (resistance matters).
- Trichomonas vaginalis ๐งช โ consider in persistent symptoms or high-prevalence settings.
- Non-infectious ๐ฅ โ trauma/irritants, urethral instrumentation, prostatitis, reactive inflammation.
๐ Clinical Tests
- NAAT โ
(first-void urine) for chlamydia + gonorrhoea (gold standard).
- Culture ๐งซ (especially if suspected gonorrhoea) to guide antibiotics/sensitivity.
- Microscopy ๐ฌ if available (PMNs; GNID suggests gonorrhoea).
- Extragenital testing ๐ฏ (pharyngeal/rectal) based on exposure.
- BBV screen ๐ฉธ โ HIV + syphilis (and hepatitis depending on risk).
๐ 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) ยฑ chlamydia cover if not excluded.
- M. genitalium: specialist/sexual health regimen (often resistance-guided).
- Trichomoniasis: metronidazole regimen (per guidance).
- Partner notification ๐ค and treat partners to prevent reinfection.
- Abstain from sex ๐ซ until treatment is complete and partners treated.
โ ๏ธ Donโt miss complications: epididymo-orchitis, prostatitis, PID in partners, and disseminated gonococcal infection (rash/arthritis).