penile discharge

Etiology: 1) mucopurulent discharge (milky) a) Neisseria gonorrhoeae b) Chlamydia trachomatis c) Ureaplasma urealyticum d) group A beta-hemolytic Streptococcus - prepubertal, uncircumcised male e) Reiter's syndrome f) Trichomonas 2) bloody discharge a) urethral injury/trauma - generally evident from history b) condylomata acuminata (venereal warts) - uncommon in urethra - always preceded by skin lesions c) ectopic prostate tissue - recurrent gross hematuria - hematospermia - dysuria - rare condition Laboratory: 1) mucopurulent discharge (milky) a) 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 b) urinalysis c) urine culture d) synovial fluid if joint effusion e) VDRL or RPR f) HIV testing 2) bloody discharge - urethrogram - cystourethrocopic exam - complete blood count Management: 1) mucopurulent discharge a) 50% of patients with Neisseria urethritis have concurrent Chlamydia infection b) 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 c) 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 d) Trichomonas - metronidazole (Flagyl) 2 g PO once 2) bloody discharge - do not catheterize bloody urethral meatus without radiographic examination - treat infection - control bleeding - surgical correction if indicated

General

sign/symptom discharge (d/c) penile disorder

References

Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 526-28