Persistent or recurrent symptoms of urethritis may be due to drug resistance, poor compliance or re-infection. In some cases there may be infection with Trichomonas vaginalis (TV).

There is new evidence suggesting high prevalence of TV in men with urethral discharge in some geographical settings. Where symptoms persist or recur after adequate treatment for gonorrhoea and chlamydia in index patient and partner(s), the patient should be treated for TV, if the local epidemiological pattern so indicates. If the symptoms still persist at follow up the patient must be referred.

For details see section 3.9.

FIGURE 2. PERSISTENT/RECURRENT URETHRAL DISCHARGE IN MEN

N.B. This flowchart assumes effective therapy for Gonorrhoea and Chlamydia to have been received and taken by the patient prior to this consultation.