The urethral discharge is found almost exclusively in humans. The main causative organisms are Neisseria gonorrhoeae (gonorrhea) and Chlamydia trachomatis (chlamydia).
The presence of a urethral discharge should be recognized in a clinical examination 1. In humans, gently massage the urethra if the flow is not visible. Urethral discharge should also be sought in patients complaining of pain / irritation during urination (dysuria).
Laboratory:
– C. trachomatis can not be readily identified by a field laboratory. In the absence of valid rapid diagnostic tests, treatment is probabilistic.
– In men, gonorrhea research can be performed on a urethral specimen after staining with methylene blue or Gram (Gram-negative intracellular diplococci).
1* In areas where lymphatic filariasis is endemic, not to be confused with a purulent urethral discharge issuing milky urine or “rice water” (chyluria), suggestive of lymphatic filariasis.
Patient treatment:
– In a man:
• If a urethral swab was achieved: in the absence of gonorrhea, chlamydia treat; in the presence of gonococci, treat for chlamydia and gonorrhea.
• In the absence of laboratory treat chlamydia and gonorrhea.
– In a woman:
Treating chlamydia and gonorrhea.
If urethral discharge persists or recurs after 7 days:
– Check that the patient received effective treatment.
(.. Eg cotrimoxazole or kanamycin) – If he received another treatment, a gonococcal resistance may be suspected: re-treat gonorrhea as above (chlamydia is rarely resistant).
– If an effective antibiotic therapy was given and that the treatment was correctly followed, think and treat trichomoniasis (tinidazole or metronidazole PO, 2 g single dose); also think about re-infection.
Partner treatment:
The sexual partner receives the same treatment as the patient, whether symptomatic or not.
