Evidence-based management of Urethral Discharge Syndrome according to Uganda Clinical Guidelines 2023

Clinical Features

Mucus or pus at the tip of the penis; staining underwear. Burning pain on passing urine (dysuria), frequent urination. Common causes: N. gonorrhoea, C. trachomatis, U. urealyticum.

Investigations

Pus swab: Gram stain, culture and sensitivity. Blood: Screen for syphilis and HIV. Examine patient carefully to confirm discharge.

First Line

Take history and examine. Milk urethra if discharge not obvious. Retract prepuce and examine for ulcers. Treat both patient and sexual partners. Ceftriaxone 250 mg IM OR Cefixime 400 mg single dose. PLUS Doxycycline 100 mg every 12 hours for 7 days.

Partner is Pregnant

Substitute doxycycline with erythromycin 500 mg every 6 hours for 7 days OR Azithromycin 1 g stat if available.

Discharge/Dysuria persists and partners were treated

Exclude ulcers under prepuce. Repeat doxycycline 100 mg every 12 hours for 7 days. Also give metronidazole 2 g single dose.

Discharge/Dysuria persists and partners were NOT treated

Start the initial treatment all over again and treat partners.

Discharge still persists

Ceftriaxone 1 g IM. Refer for specialist management if not better.