Urethral discharge

This excretion 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.) Then obtain a urine sample for urinalysis, culture, and possibly a three-glass urine sample. (See Performing the three-glass urine test, page 608.) In the male patient, the prostate gland may have to be palpated.

Medical causes

Prostatitis

Acute prostatitis is characterized by purulent urethral discharge. Initial signs and symptoms include sudden fever, chills, lower back pain, myalgia, perineal fullness, 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, although often asymptomatic, 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, as in the morning. Associated effects include a dull aching in the prostate or rectum, sexual dysfunction such as ejaculatory pain, and urinary disturbances such as frequency, urgency, and dysuria.

Reiter’s syndrome

In Reiter’s syndrome — a self-limiting syndrome that usually affects males — 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 with Reiter’s syndrome.

Urethritis

Urethritis, which is usually sexually transmitted (as in gonorrhea), commonly produces 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 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: Handbook of Signs & Symptoms (Third Edition)
• Author(s): Springhouse
• Year of Publication: 2006
• Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2006 Lippincott Williams & Wilkins.

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