Urethral discharge

Urethral discharge from the urinary meatus may be purulent, mucoid, or thin; sanguineous or clear; and scant or profuse. It usually develops suddenly, most commonly in men with a prostate infection.

History and physical examination

Ask the patient when he first noticed the discharge, and have him describe its color, consistency, and quantity. Does he experience pain or burning on urination? Does he have difficulty initiating a urine stream? Does he experience urinary frequency? Ask the patient about other associated signs and symptoms, such as fever, chills, and perineal fullness. Explore his history for prostate problems, sexually transmitted disease, or urinary tract infection. Ask the patient if he has had recent sexual contacts or a new sexual partner.

Inspect the patient’s urethral meatus for inflammation and swelling. Using proper technique, obtain a culture specimen. (See Collecting a urethral discharge specimen, page 778.) Then obtain a urine specimen for urinalysis, culture and, possibly,, a three-glass urine test. (See How to perform the three-glass urine test.) Palpation of the male patient’s prostate gland may be necessary.

Medical causes

Prostatitis

Acute prostatitis is characterized by a purulent urethral discharge. Initial signs and symptoms include sudden fever, chills, low back pain, perineal fullness, myalgia, and arthralgia. Urination becomes increasingly frequent and urgent, and the urine may appear cloudy. Dysuria, nocturia, and some degree of urinary obstruction may also occur. The prostate may be tense, boggy, tender, and warm. Prostate massage to obtain prostatic fluid is contraindicated.

Chronic prostatitis commonly produces no symptoms, but it may produce a persistent urethral discharge that’s thin, milky or clear, and sometimes sticky. The discharge appears at the meatus after a long interval between voidings—for example, in the morning. Associated effects include a dull ache in the prostate or rectum, sexual dysfunction such as ejaculatory pain, and urinary disturbances, such as frequency, urgency, and dysuria.

Reiter’s syndrome

In this self-limiting syndrome that usually affects males, a urethral discharge and other signs of acute urethritis occur 1 to 2 weeks after sexual contact. Asymmetrical arthritis, conjunctivitis of one or both eyes, and ulcerations on the oral mucosa, glans penis, palms, and soles may also occur.

Urethral neoplasm

This rare cancer is sometimes heralded by a painless urethral discharge that’s initially opaque and gray and later yellowish and blood-tinged. Dysuria progresses to anuria as the urethra becomes blocked.

Urethritis

This inflammatory disorder, which is often sexually transmitted (as in gonorrhea), commonly produces a scant or profuse urethral discharge that’s either thin and clear, mucoid, or thick and purulent. Other effects include urinary hesitancy, urgency, and frequency; dysuria; and itching and burning around the meatus.

Special considerations

Advise the patient with acute prostatitis to discontinue sexual activity until acute symptoms subside. However, encourage the patient with chronic prostatitis to regularly engage in sexual activity because ejaculation may relieve pain. To help this patient relieve symptoms, suggest that he take hot sitz baths several times daily, increase his fluid intake, void frequently, and avoid caffeine, tea, and alcohol. Monitor him for urine retention.

Pediatric pointers

Carefully evaluate a child with a urethral discharge for evidence of sexual and physical abuse.

Geriatric pointers

Urethral discharge in elderly males isn’t usually related to a sexually transmitted disease.

Pictures

Book Source Details

• Book Title: Professional Guide to Signs & Symptoms (Fifth Edition)
• Author(s): Springhouse
• Year of Publication: 2006
• Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2006 Lippincott Williams & Wilkins.

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Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2008 Williams & Wilkins.

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More About This Book: Title: Professional Guide to Signs & Symptoms (Fifth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2006 ISBN: 1-58255-510-9

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