Male purulent urethral drip

Specialty: Nephrology and urology.

• purulent urethrorrhea
• gonorrhea
• greenish or yellowish urethral discharge

Why it occurs

• Gonococcal urethritis (acute bacterial infection of sexual transmission by Neisseria gonorrhoeae that causes intense inflammation of the anterior urethral mucosa with a creamy, abundant, thick, green or yellow exudate, typically 2 to 5 days after the risky contact)
• Refractory non-gonococcal urethritis (bacterial infection by bacteria such as Mycoplasma genitalium or Ureaplasma urealyticum that presents with mucopurulent discharge of lower density)
• Acute complicated bacterial prostatitis (with involvement of the ejaculatory duct and prostatic urethra that drains purulent material through the anterior urethra)
• Complicated urethral or periurethral abscess

Initial workup

Direct sampling of urethral secretion before first morning urination for Gram stain (visualization of intracellular Gram-negative diplococci in polymorphonuclear cells confirms gonococcal urethritis); specific microbiological culture in Thayer-Martin medium; first portion urine multiplex PCR test for Chlamydia, Gonococcus and Mycoplasma; Scrotal ultrasound if epididymal pain is associated.

Standard management

• Ceftriaxone — 500 mg intramuscularly in a single dose, treatment of choice for Neisseria gonorrhoeae) associated with Doxycycline (100 mg every 12 hours orally for 7 days for the usual empirical coverage of concomitant Chlamydia trachomatis
• Azithromycin — 1 g orally in a single dose as an alternative to doxycycline
• Ibuprofen (400 mg every 8 hours orally for 5 days to control pain and urethral edema).