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ULY CLINIC

ULY CLINIC

19 Septemba 2025, 04:35:01

Urethral discharge

Urethral discharge
Urethral discharge
Urethral discharge

Urethral discharge is the excretion of fluid from the urinary meatus, which may be purulent, mucoid, thin, sanguineous, or clear. The volume may range from scant to profuse. It typically develops suddenly, most commonly in men with prostate infection or urethritis, and may indicate sexually transmitted infections (STIs) or other urinary tract pathology.


Pathophysiology

  1. Prostatitis: Infection and inflammation of the prostate gland produce increased prostatic secretions, which may exit via the urethra.

  2. Urethritis: Inflammation of the urethral mucosa, often due to Neisseria gonorrhoeae, Chlamydia trachomatis, or other pathogens, causes mucopurulent exudate.

  3. Reiter’s Syndrome (Reactive Arthritis): Post-infectious autoimmune response leads to urethritis and systemic manifestations (arthritis, conjunctivitis, mucocutaneous lesions).

  4. Chronic prostatitis: May cause persistent, milky, or clear discharge due to low-grade inflammation of the prostate and seminal vesicles.


History and Physical Examination

History

  • Onset and progression: Sudden or gradual, intermittent or persistent.

  • Discharge characteristics: Color, consistency (thin, mucoid, purulent), quantity.

  • Associated urinary symptoms: Dysuria, burning, frequency, urgency, hesitancy, nocturia, weak stream.

  • Other systemic symptoms: Fever, chills, perineal fullness, lower back pain, arthralgia.

  • Sexual history: Recent sexual contacts, new partners, history of STIs.

  • Past medical history: Prostate disease, urinary tract infection, recent instrumentation or surgery.


Physical Examination

  • Inspect urethral meatus: Look for erythema, swelling, and presence of discharge.

  • Obtain specimens: Collect urethral discharge for culture using proper technique.

  • Urine testing: Perform urinalysis, culture, and consider the three-glass urine test for prostatitis evaluation.

  • Prostate examination (male): Palpate for tenderness, bogginess, enlargement; avoid prostate massage in acute prostatitis due to risk of bacteremia.

  • Systemic examination: Assess for fever, lymphadenopathy, signs of Reiter’s syndrome (arthritis, conjunctivitis, mucocutaneous lesions).



Medical causes

Cause

Onset

Key Features

Associated Signs

Pathophysiology

Management

Acute prostatitis

Sudden

Purulent urethral discharge, dysuria

Fever, chills, lower back pain, myalgia, perineal fullness

Bacterial infection (often E. coli) → prostate inflammation

Empiric antibiotics, analgesia, hydration, bed rest, avoid prostate massage, monitor urine retention

Chronic prostatitis

Gradual, persistent

Thin, milky, or clear urethral discharge; may appear in morning

Dull perineal/rectal ache, ejaculatory pain, urinary frequency/urgency

Low-grade chronic inflammation of prostate/seminal vesicles

Long-term antibiotics, symptom management, increased fluids, sitz baths, sexual activity may help symptom relief

Urethritis (STI-related, e.g., gonococcal, chlamydial)

Acute

Scant to profuse discharge: thin, mucoid, or purulent

Dysuria, urinary frequency, itching/burning at meatus

Infection/inflammation of urethral mucosa

Appropriate antibiotic therapy based on causative organism, partner notification, abstain until treatment complete

Reiter’s syndrome (reactive arthritis)

1–2 weeks post-infection

Urethral discharge, acute urethritis

Asymmetrical arthritis, conjunctivitis, mucocutaneous lesions

Autoimmune response post-infection

NSAIDs, antibiotics for triggering infection, supportive care

Iatrogenic/post-procedural

Variable

Discharge post-catheterization or instrumentation

Local erythema, dysuria

Mechanical irritation or infection

Symptomatic care, antibiotics if infection confirmed


Special considerations

  • Acute prostatitis: Advise hot sitz baths several times daily, increased fluid intake, frequent voiding, and avoidance of caffeine, tea, and alcohol. Monitor for urinary retention.

  • Three-glass urine test:

    1. Glass #1: First-voided urine (anterior urethra).

    2. Glass #2: Midstream urine (bladder).

    3. Glass #3: Residual urine (prostate and seminal vesicles).

  • Observation: Note urine color, odor, and presence of pus/mucus shreds. Confirm diagnosis via microscopy and culture.


Urethral discharge specimen collection in males and females:

Patient

Procedure

Notes / Precautions

Male

1. Void a small amount of urine first (optional).


2. Retract foreskin if uncircumcised.


3. Collect discharge from urethral meatus using a sterile swab.


4. Rotate swab gently to absorb sample.


5. Place swab into transport medium.

- Avoid touching surrounding skin.


- Collect before starting antibiotics.


- Refrain from urinating 1–2 hours before collection if possible.

Female

1. Patient lies in lithotomy position.


2. Gently separate labia minora.


3. Collect discharge from urethral meatus using sterile swab.


4. Rotate swab gently.


5. Place swab into transport medium.

- Avoid contaminating swab with vaginal secretions.


- Collect before antibiotics.


- Mild discomfort may occur.

Patient counseling

  • Acute prostatitis: Avoid sexual activity until acute symptoms subside.

  • Chronic prostatitis: Regular sexual activity may relieve symptoms.

  • STI-related urethritis: Complete full course of antibiotics, abstain until partner treated, and practice safe sex.

  • General: Maintain hydration, practice good genital hygiene, and follow-up for persistent or recurrent symptoms.


Pediatric pointers

  • Urethral discharge in children warrants careful evaluation for sexual or physical abuse.

  • Assess for congenital or urinary tract anomalies if infection suspected.


Geriatric pointers

  • In elderly males, urethral discharge is less likely due to STIs; more commonly associated with prostatitis or urinary tract infection.

  • Consider comorbidities such as benign prostatic hyperplasia or catheterization.


References

  1. Buttaro TM, Tybulski J, Bailey PP, Sandberg-Cook J. Primary Care: A Collaborative Practice. 2nd ed. St. Louis, MO: Mosby Elsevier; 2008. p. 444–447.

  2. McCance KL, Huether SE, Brashers VL, Rote NS. Pathophysiology: The Biologic Basis for Disease in Adults and Children. 7th ed. Mosby Elsevier; 2010.

  3. Sommers MS, Brunner LS. Pocket Diseases. Philadelphia, PA: F.A. Davis; 2012.

  4. Nickel JC. Prostatitis: Clinical and basic research update. World J Urol. 2002;20:319–330.

  5. Stamm WE, Hooton TM. Management of urinary tract infections in adults. N Engl J Med. 1993;329:1328–1334.

  6. Hook EW 3rd, Handsfield HH. Gonococcal infections in the adult. In: Jameson JL, Fauci AS, Kasper DL, Hauser SL, Loscalzo J, editors. Harrison’s Principles of Internal Medicine. 20th ed. New York, NY: McGraw-Hill; 2018.

  7. Schaeffer AJ. Chronic prostatitis. Rev Urol. 2006;8(Suppl 5):S16–S23.

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