Urethritis in males

K Pavithran

 Department of Dermatology & Venereology, Medical College Hospital, Calicut - 673 008, India

Correspondence Address:
K Pavithran
Department of Dermatology & Venereology, Medical College Hospital, Calicut - 673 008
India

Sexually transmitted urethritis in males may be gonococcal or nongonococcal. Gonococcal urethritis (GCU) usually presents with severe dysuria and profuse mucopurulent urethral discharge. The external meatus is often erythematous and oedematous. Nongonococcal urethritis (NGU) on the other hand presents with scanty mucoid or purulent urethral discharge or sometimes may be completely asymptomatic.

A 2 glass test helps to assess the extent of infection. Presence of pus or ′threads′ in the first glass only indicates anterior urethritis alone. If both glasses show pus, it indicates affection of the posterior urethra also. Pus cells> 10 per high power field in the centrifuged specimen of urine indicates infection. Threads, if any can be taken from the glass using a swab and examined under microscopy.

Gram staining of the pus taken from the external urethral meatus, in case of GCU revels numerous pus cells and gram-negative reneform intracellular diplococci. In case of NGU only pus cells are seen. If there is no urethral discharge milking of the urethra may yield some discharge in cases of NGU. More than 5 polymorphonuclear leucocytes per oil immersion field on a smear of intraurethral swab specimen is also diagnostic of NGU. In medico-legal cases gonorrhoea is to be confirmed by culture and sugar fermentation test. In cases of NGU that do not respond to standard treatment for chlamydia, urethral discharge is examined in 10% KOH to show candida and in N.saline to show Trichomonas vaginalis. A blood VDRL test is done on the first day of visit to the clinic and then every month for 3 months. A screening test for HIV is also done, if patient gives consent.

The treatment of acute gonorrhoea consists one of the following.

1. Tab norfoxacin 800ng single dose

2. Inj. ceftriaxone 250ng IM in a single dose.

This is followed by cap. doxycycline 100 mg. orally twice daily for 7 days to treat possible coinfection with C. trachomatis.

Doxycycline is to be taken after food and with a glass of water so that it will not stick to the oesophageal wall. Those who can afford, azithromycin 1g is given as single dose to treat both GCU and NGU.

Sex partner of the patient is always given the same treatment even if there is no clinical or laboratory evidence of urethritis (epidemiological treatment).

The patients are advised to avoid sexual inter-course and exercise, till complete cure is achieved. They should avoid alcohol also. Usually they are followed up on 7th, 14th, 28th days and then at the end of 3rd month when a blood VDRL test is repeated. If signs and symptoms persists after 10-14 days, pus is sent for culture in blood agar, to detect any drug resistant strains of gnococci.