What is penile discharge?Penile discharge is the abnormal loss of fluid that is not urine or semen from the urethra (urine tube) at the tip of the penis.
It is commonly the sign of a sexually transmitted disease (STD), and it requires prompt and accurate diagnosis and treatment, usually by staff at a specialist genitourinary medicine (GUM) or STD clinic.
What are the symptoms?The discharge can vary in amount from scanty to profuse and in colour from clear to yellow or green. Without treatment, symptoms of urethritis (inflammation of the urethra) and purulent (pus containing) discharge peak within two weeks.
Symptoms: discharge occurs in 95 per cent of men and is purulent in 75 per cent, white or cloudy in 10 per cent and clear in 5 per cent. Recent urination can make the discharge appear less purulent. When the infection begins to resolve, the discharge changes from purulent to mucoid (mucus like).
Transmission: transmitted by sexual intercourse, including oral sex. Without treatment, the infection can continue for many months.
Complications: spread up the urethra to the epididymis (sperm storing tube connected to the testicles) is rare and infertility can be a rare late complication. Anal infection is common especially, but not only, when the infection is transmitted by anal intercourse.
Men aged between 20 and 35 years are most commonly affected. Recently there has been an increase in all STIs. They are increasing as a result of failing relationships, effective treatments for erectile dysfunction (ED) and opportunities for travel to high risk areas.
Ureaplasma urealyticum (15 to 25 per cent).
Trichomonas vaginalis (17 per cent).
In some patients, no sexual contact has occurred and the symptoms are blamed on irritants, soaps or detergents. But no firm evidence exists to support this theory.
How is the diagnosis made?Penile discharge or urethritis is diagnosed by finding white blood cells (neutrophils or pus cells) on a urethral swab or ‘first catch’ urine sample (ie urine taken from when you first begin to pass water).
The infecting organism might be identified from these samples.
Ideally, the patient should be seen in an STD clinic for prompt examination of specimens because transfer of specimens to a hospital laboratory can lead to a missed diagnosis.
The colour and consistency of the discharge does not help to distinguish NSU from gonococcal urethritis.
Gonococcal urethritis is diagnosed in 98 per cent of men by microscopic examination of the discharge obtained from a urethral swab.
Other infections are less easily diagnosed. Between 6 and 11 per cent of sexually active UK men carry chlamydia in their urethra with minimal or no symptoms.
The development of more sensitive tests, such as polymerase chain reaction and ligase chain reaction, might allow for more precise diagnosis, particularly in patients with no symptoms and especially if they are sexual contacts of proven infected women. But this is not used routinely in STD clinics. Sexual partners are given similar treatment.
NSUUsual antibiotic treatment includes doxycycline 100mg twice daily for seven days or a single dose of azithromycin 2g as a single dose if the infection is due to Chlamydia trachomatis, according to the British Association for Sexual Health and HIV (BASHH) guidelines.
Sexual partners should be given similar treatment. Patients should be followed up after two weeks with repeat swabs (known as ‘test of cure’) because of the high risk of re infection often due to failure of all sexual partners to comply with therapy.
Contact tracingIt is essential that sexual contacts of men with gonococcal urethritis and NSU are traced and treated, preferably in an STD clinic.