Male patients complaining of urethral discharge and/or dysuria should be examined for evidence of discharge. If none is seen, the urethra should be gently massaged from the ventral part of the penis towards the meatus.

If microscopy is available, examination of the urethral smear may show an increased number of polymorphonuclear leukocytes and a gram stain may demonstrate the presence of gonococci. In the male, more than 5 polymorphonuclear leukocytes per high power field (× 1000) are indicative of urethritis.

The major pathogens causing urethral discharge are N. gonorrhoeae and Chlamydia trachomatis (C. trachomatis). In the syndromic management, treatment of a patient with urethral discharge should adequately cover these two organisms. Where reliable laboratory facilities are available, a distinction may be made between the two organisms and specific treatment instituted.

Recommended syndromic treatment

• therapy for uncomplicated gonorrhoea (for details see section 3.1)

PLUS

• therapy for chlamydia (for details see section 3.2)

• Patients should be advised to return if symptoms persist 7 days after start of therapy.

AT A GLANCE

Urethral Discharge

For details, see section 3.1 and 3.2

WHO recommends that, where possible, single dose therapy be utilized.

FIGURE 1. URETHRAL DISCHARGE