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Clinical investigations from the RACP

Urethral discharge in men: not a trivial symptom

Marcus Y Chen, Basil Donovan

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Abstract

A male patient with a urethral discharge may be the only indication that serious sexually transmitted infections are circulating in a community. Australia is progressively losing control of the pathogens that lead to urethral discharge: GPs are pivotal to restoring that control.

Key Points

  • Increasing notifications of chlamydial infection and gonorrhoea indicate that Australia is losing control of these sexually transmitted infections (STIs), with serious implications for sexual partners and enhanced HIV transmission.
  • Opportunistic testing in general practice of asymptomatic young men who are at high risk of STIs, as well as women, is one way to help restore control of these infections.
  • DNA testing of first void urine for Chlamydia trachomatis has revolutionised the assessment of these men. DNA testing for Neisseria gonorrhoeae is available but needs further evaluation.
  • Single oral dose treatment with azithromycin is appropriate for most men with nongonococcal urethritis, while the ever-evolving antibiotic resistance of N. gonorrhoeae makes single dose intramuscular ceftriaxone the treatment of choice for gonorrhoea.
  • The diagnosis of urethritis, chlamydial infection or gonorrhoea in a man should act as a trigger to ensure that his sexual partner(s) are also assessed.

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