emergency medicine at ncemi   More Emergency Medicine Resources
Back to table of contents

7.04 Urethritis (Drip)


Presentation

A male complains of dysuria, a burning discomfort along the urethra, or a urethral discharge. A copious, thick, yellow- green discharge which stains underwear is characteristic of gonorrhea, whereas a thin, white, scant discharge with milder symptoms is characteristic of chlamydia. Urethritis in a female may be asymptomatic or indistinguishable from cystitis or vaginitis, or may be manifest as UTI symptoms with a low concentration of bacteria on urine culture, or tenderness localized to the anterior vaginal wall. In addition to increased vaginal discharge, women may have intermenstrual bleeding, especially postcoital spotting and cervical friability.

What to do:

What not to do:

Discussion

Cultures and fluorescent antibody tests to diagnose chlamydia are expensive and insensitive, so presumptive treatment remains the best strategy. Many gonorrhea victirns develop a rebound urethritis, probably with chlamydia, following single dose antibiotic treatment.

Non-gonococcal urethritis is the most common sexually treated disease in US men. Complications include acute epididymitis, Reiter's syndrome and persistent or recurrent urethritis. More important, failure to identify and treat non-gonococcal urethritis places female sexual partners at risk for mucopurulent cervicitis, pelvic inflammatory disease, ectopic pregnancy and tubal infertility. Sexually-transmitted infections that produce cervical inflammation in women and urethritis in men man facilitate transmission of human immunodeficiency virus (HIV).

References:


Table of Contents
from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
Longwood Information LLC 4822 Quebec St NW Washington DC 20016-3229
1.202.237.0971 fax 1.202.244.8393 electra@clark.net
Emergency Medicine at NCEMI   More emergency medicine resources
Write to us at NCEMI
Craig Feied, MD
Mark Smith, MD
Jon Handler, MD
Michael Gillam, MD