penile discharge

Etiology

• mucopurulent discharge (milky)
  • Neisseria gonorrhoeae
  • Chlamydia trachomatis
  • Ureaplasma urealyticum
  • group A beta-hemolytic Streptococcus
    • prepubertal, uncircumcised male
  • Reiter's syndrome
  • Trichomonas
• bloody discharge
  • urethral injury/trauma
    • generally evident from history
  • condylomata acuminata (venereal warts)
    • uncommon in urethra
    • always preceded by skin lesions
  • ectopic prostate tissue
    • recurrent gross hematuria
    • hematospermia
    • dysuria
    • rare condition

Laboratory

• mucopurulent discharge (milky)
  • specimen from penile discharge
    • Chlamydia trachomatis + Neisseria gonorrhoeae DNA
    • gram stain of discharge
    • culture
      • Neisseria gonorrhoeae
      • Chlamydia trachomatis
    • collect at least 1 hour after last void
    • calcium alginate swab inserted 2-3 cm into urethral meatus & gently rotated
  • urinalysis
  • urine culture
  • synovial fluid if joint effusion
  • VDRL or RPR
  • HIV testing
• bloody discharge
  • urethrogram
  • cystourethrocopic exam
  • complete blood count

Management

• mucopurulent discharge
  • 50% of patients with Neisseria urethritis have concurrent Chlamydia infection
  • Neisseria gonorrhoeae
    • ceftriaxone (Rocephin) 250 mg IM once
    • cefixime (Suprax) 400 mg PO once
    • ciprofloxacin (Cipro) 500 mg PO once
    • ofloxacin (Floxin) 400 mg PO once
  • Chlamydia
    • doxycycline (Vibramycin) 100 mg PO BID for 7 days
    • azithromycin (Zithromax) 1 g PO once
    • ofloxacin (Floxin) 300 mg PO BID for 7 days
    • erythromycin 500 mg PO BID
  • Trichomonas
    • metronidazole (Flagyl) 2 g PO once
• bloody discharge
  • do not catheterize bloody urethral meatus without radiographic examination
  • treat infection
  • control bleeding
  • surgical correction if indicated

More general terms

• sign/symptom
• discharge (d/c)
• penile disorder