Urethral discharge in the male

Urethritis in the male is frequent, and is almost always sexually transmitted. It is classically divided into gonorrhea, and nongonococcal urethritis. By definition, men with gonorrhea have Neisseria gonorrhoeae present, but approximately 20% also have Chlamydia trachomatis. C. trachomatis is present in 30%-50% of men with acute nongonococcal urethritis. The specific etiologic diagnosis requires laboratory evaluation. Recommended treatment for urethritis includes a one-week regimen of a tetracycline for all men, plus a single-dose regimen active against N. gonorrhoeae in men in whom gonorrhea is proven or has not been excluded. Partners should be investigated and should receive similar treatment. Recurrence of nongonococcal urethritis is frequent after treatment, but the condition is only rarely the result of persistent C. trachomatis infection. Men with recurrent urethritis require re-evaluation. If no cause is found or if Ureaplasma urealyticum is isolated, the men are treated with a two-week course of erythromycin. If there are subsequent recurrences, they are usually left untreated.