Guidelines for the Management of Sexually Transmitted Infections. February 2004
(2004; 88 pages)
Table of Contents
View the documentPREFACE
Open this folder and view contents1. INTRODUCTION
Close this folder2. TREATMENT OF STI-ASSOCIATED SYNDROMES
Close this folder2.1. Urethral discharge
View the document2.1.1. Persistent or recurrent urethral discharge
Open this folder and view contents2.2. Genital ulcer
View the document2.3. Scrotal swelling
Open this folder and view contents2.4. Vaginal discharge
View the document2.5. Lower abdominal pain
View the document2.6. Neonatal conjunctivitis
Open this folder and view contents3. TREATMENT OF SPECIFIC INFECTIONS
Open this folder and view contents4. KEY CONSIDERATIONS UNDERLYING TREATMENTS
Open this folder and view contents5. PRACTICAL CONSIDERATIONS IN STI CASE MANAGEMENT
Open this folder and view contents6. CHILDREN6, ADOLESCENTS AND SEXUALLY TRANSMITTED INFECTIONS
View the documentANNEX. LIST OF PARTICIPANTS
 

2.1. Urethral discharge

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

Treatment options for Gonorrhoea

Treatment options for Chlamydia

Ciprofloxacin

Doxycycline

Azithromycin

Azithromycin

Ceftriaxone

 

Cefixime

 

Spectinomycin

 

Alternatives

Alternatives

Kanamycin

Amoxycillin

Trimethoprim/Sulfamethoxazole

Erythromycin (if Tetracycline contraindicated)

 

Ofloxacin

 

Tetracycline

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


FIGURE 1. URETHRAL DISCHARGE

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