Penile discharge

Overview
Penile discharge is commonly associated with STDs. A thorough sexual history along with a complete medical history and physical exam are necessary. In addition, cultures for STDs should be taken though rarely are nonsexually transmitted diseases the cause. A patient that is not circumscised is at higher risk for STDs.

Differential Diagnosis

 * Carcinoma of the urethra
 * Foreign body in the urethra
 * Infection
 * Nonspecific urethritis
 * Prostatitis
 * Reiter's Syndrome

History and Symptoms

 * History includes:
 * personal history
 * sexual history


 * Note: onset, color, type and duration of discharge

Other

 * Genital exam

Laboratory Findings

 * Blood culture
 * CBC
 * Hepatitis B
 * Hepatitis C antibodies
 * HIV
 * RPR
 * Urethral cultures - Gold standard for gonorrhea and chlamydia
 * Urinalysis
 * Wet mount for trichomonas

X Ray

 * X-ray for detection of foreign bodies, when necessary

Treatment

 * Penile discharge should be treated as an STD until definitivly ruled out

Acute Pharmacotherapies

 * Chlamydia - PO azithromycin, ofloxacin for seven days, doxycycline for seven days or erythromycin for seven days
 * Trichomonas - Single dose metronidazole for seven days
 * Gonorrhea - Ceftriaxone single dose IM (in office) / PO cefixime / ciprofloxacin

Primary Prevention

 * Suggest the patient inform all sexual partners of disease so they can seek treatment
 * Discuss safe sexual practice

Acknowledgements
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