Penile Discharge

Penile discharge is a common complaint that requires a thorough history, including a complete and accurate sexual history and a thorough physical examination that includes cultures and evaluation for common sexually transmitted diseases. Less commonly, nonsexually transmitted diseases are the etiology of penile discharge.

Differential Diagnosis

• Infection
  –Neisseria gonorrhoeae: Profuse, purulent, thick yellow or gray discharge; presents as urethral discharge and dysuria, ±urinary urgency or frequency; untreated primary gonorrhea may progress to disseminated gonococcal infection [clinical triad includes tenosynovitis (asymmetric, involving small joints), dermatitis (erythematous macules that progress to pustules with a hemorrhagic component), and arthritis]
  –Chlamydia trachomatis: Most common cause of nongonococcal urethral discharge; thin, scant, and mucoid (watery)
  –Trichomonas vaginalis: Usually asymptomatic in men but may present with penile discharge and dysuria; female partner tends to be symptomatic, with pelvic pain, itching, and vaginal discharge
• Nonspecific urethritis
• Prostatitis
• Carcinoma of the urethra
  –Presents with bloody penile discharge
• Foreign body in the urethra
  –Presents with pain and bloody discharge
• Reiter's syndrome
  –Triad of urethritis, conjunctivitis, and arthritis (“can’t see, can’t pee, can’t climb a tree”) is associated with Chlamydia infection
  –Skin lesions involve the palms and soles, begin as vesicles, and become hyperkeratotic
• Lack of circumcision may increase the risk of HIV, gonorrhea, and ulcerative chancres (syphilis)

Workup and Diagnosis

• History and physical examination, including sexual history and genital exam
  –Note onset, duration, and character of discharge (thin versus thick; color; presence of blood or odor)
• Urethral cultures are the gold standard for diagnosis of gonorrhea and Chlamydia
  –Obtain cultures by holding the penis up and carefully inserting the tip of the culture swab into the meatus about 1/2 inch; twirl, remove, and place in culture medium

• Wet mount to evaluate for trichomonads
  –To express penile discharge, have the patient “milk” the penis from the base up to the tip

Treatment

• Penile discharge without dysuria or frequency should be treated as an STD until proven otherwise
• Begin empiric antibiotic therapy upon clinical suspicion
  –Gonorrhea: Single-dose ceftriaxone IM (give in office for 100% compliance) or PO cefixime or ciprofloxacin
  –Chlamydia: PO azithromycin single dose, doxycycline (7 days), ofloxacin (7 days), or erythromycin (7 days)
  –Trichomonas: Metronidazole single dose or for 7 days
• If cultures are positive, obtain test of cure 6–8 weeks after initiating antibiotic treatment
• Encourage patient to inform sexual partners of disease so that they can be treated also, and inform the health department if required
• Use this visit with the patient to educate about safe sex and the use of barrier methods to decrease STD transmission, and to test for other STDs
• Emergent urology consult is required for foreign bodies or carcinoma of the penis

Book Source Details

• Book Title: In a Page: Signs and Symptoms
• Author(s): Scott Kahan, Ellen G. Smith
• Year of Publication: 2004
• Copyright Details: In a Page: Signs and Symptoms, Copyright © 2004 Lippincott Williams & Wilkins.

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Copyright Details: In a Page: Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

More About Causes of Penis symptoms

• Back to symptom: Penis symptoms: Introduction (review 326 causes)
• Next Book Extract About Penis symptoms: Priapism (In a Page: Signs and Symptoms)
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More About This Book: Title: In a Page: Signs and Symptoms Authors: Scott Kahan, Ellen G. Smith Publisher: Lippincott Williams & Wilkins Copyright: 2004 ISBN: 1-4051-0368-X

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