Penile Discharge

The amount of discharge varies from person to person. Some patients may have copious discharge enough to stain your underwear, and occasionally patients feel the need to wrap their penis in tissues to contain the discharge. On the other hand, some patients may just experience a little ‘wetness’ at the tip.

The length of discharge you experience may be for a couple of days to weeks after getting an infection. However, the disappearance of discharge does not mean you have become clear of an infection. We often find that such patients do not seek a diagnosis for the underlying infection and as such cannot receive the right treatment and ultimately reduce the risk of onward transmission. If there is ongoing inflammation in the urethra, especially in the case of gonorrhoea, there is an increased risk in the scarring of the waterpipe (urethral stricture formation).

You may also notice threads in the urine which may cause your urine to go cloudy in colour.

If you have penile discharge that is not pre-ejaculate or semen, we advise that you seek medical advice as this is not a normal occurrence and requires medical attention.

In men, penile discharge is often a telltale sign of infection, especially when presenting with other symptoms such as painful urination and pain during sexual intercourse.

STIs which cause penile discharge:

• Chlamydia: White, cloudy, pus-like, watery discharge. Other symptoms include painful urination and pain in testicles.
• Gonorrhoea: Copious amount of yellow or green muco-purulent discharge. Similar symptoms to Chlamydia (hence why we test for the two infections together). Can cause Gonococcal urethritis.
• Trichomonas vaginalis: White and thin in consistency (mild) discharge. Most men are asymptomatic - women tend to suffer more with symptoms. This is why partners should be tested and treated. Can cause painful urination.
• Mycoplasma genitalium: Discharge similar to that produced by Chlamydia & Gonorrhoea. M.genitalium test is often recommended in the event of negative test results for Chlamydia & Gonorrhoea + presence of discharge. Other symptoms include discomfort/not feeling right, inflammation of the foreskin or penis, pain in the back passage, painful urination, and raised inguinal lymph nodes.

Rarely, genital herpes can cause discharge from the penis, though this is not a typical symptom.

Remember, most STIs can present without symptoms in many patients.

Other causes of penile discharge:

It is rare for sexually active men to have penile discharge in the absence of an STI, especially those under the age of 35. However, other possible causes of discharge in men include:

• Urethritis: the inflammation of the urethra (the tube that carries urine).
• Urinary tract infection: an umbrella term to describe any infection of the kidneys, pelvis, ureters, bladder, urethra and prostate.
• Prostatitis: the inflammation of the prostate gland and the areas around it.
• Balanitis: the inflammation of the head, or glans of the penis.
• Smegma: a thick white or yellow substance which can be mistaken for discharge.

Penile discharge can be suggestive of an underlying infection. Trying to determine the cause of this requires a thorough assessment which will look at your medical, surgical, social and sexual history.

A physical examination of genitalia is very helpful, and in many cases allows the clinicians to make a presumptive diagnosis, and enables them to request extra tests where necessary (for example, Gonorrhoea culture in suspected cases) and will allow the clinicians to prescribe the appropriate antibiotics before the final results are available.

Many men find it daunting to have their genitalia examined by a clinician. You can rest assured that our clinicians will examine you with utmost respect, dignity, and professionalism. You will also have the presence of a chaperone to support you if you prefer.

The following tests are undertaken to establish the cause of your penile discharge:

• Chlamydia
• Gonorrhoea
• Trichomonas vaginalis
• Mycoplasma genitalium
• Urine dipstick
• Urine Culture & Sensitivity Test (where appropriate)

In most cases, it is reassuring to have negative test results, and no further tests or treatment is needed. However, if symptoms persist, other causes of penile discharge are considered. This may require assessment of the prostate and an ultrasound scan. Occasionally, a referral may be required for further urological investigations. We can write to your GP with our advice, or refer you directly to a Consultant Urologist privately.

In our experience, the most common cause of penile discharge is STIs. Therefore the treatment in the form of antibiotics is selected on the basis of STI test results.

Recommendations on the choice as well as the dose of antibiotics is an area of specialised practice, and guided by current sensitivity patterns of various infections. For example, gonorrhoea is well known to develop resistance against the recommended antibiotics.

Presence of pain in testicles, genitalia or perineum in the patients with penile discharge indicates possible local spread of the infection, and thus longer courses of antibiotics are prescribed in such cases.

Those with discharge as a result of Non-specific urethritis are treated with the same course of antibiotics which treat discharge related to Chlamydia infection.

This is why it is essential to first collect the urine specimen and identify the cause before administering antibiotics. However, there may be times where your clinician recommends that you initiate treatment before your results come back (i.e. if you are experiencing symptoms, or you are a sexual contact of someone who has an STI).

If the cause of penile discharge is not an STI, we can also offer oral antibiotics/antifungals to treat the discharge.

It’s important to recognise that sometimes it may take several weeks for symptoms to resolve completely. We often see patients who continue to have urethral discharge despite negative tests for chlamydia and gonorrhoea, or their successful treatment after test results are positive. Further tests can lead to a diagnosis of other STIs like Mycoplasma genitalium or Trichomonas vaginalis.

If all STI causes have been ruled out, we will need to consider possible risks of re-infection and possible refer to a urologist.

If the cause of your discharge is an STI, then yes. We recommend your partner receive testing and treatment as soon as possible – this will also prevent the likelihood of re-infection to you.

If sexually transmitted, then we recommend you wait until after you and your partner(s) have completed treatment before resuming sexual intercourse. This will ensure the infection has completely cleared, and that you will not reinfect each other.

If non-sexually transmitted, we recommend waiting until you have finished treatment, and symptoms have resolved before having sex again. This will help to reduce any unnecessary pain, prevent worsening the infection, or delaying the healing process.

Complications of STI-related penile discharge:

There are a wider range of complications from untreated STIs, but these can be avoided if you get tested and treated promptly.

• In men, Chlamydia, Gonorrhoea & Mycoplasma genitalium can lead to Epididymitis or Epididymo-orchitis (inflammation of testicles and epididymis (tube carrying sperm from testicles)).
• In women, Chlamydia, Gonorrhoea & Mycoplasma genitalium can lead to Pelvic Inflammatory Disease (PID), chronic pelvic pain, difficulty conceiving, risk of ectopic pregnancy, premature birth and risk of passing Chlamydia onto the newborn during delivery.
• In men and women, Chlamydia, Gonorrhoea & Mycoplasma genitalium can lead to SARA (Sexually Acquired Reactive Arthritis), risk of infertility if the below complications are left untreated.
• Fortunately, documented complications are rare in those with Trichomonas vaginalis. However, in both men and women, growing evidence suggests that TV may increase the risk of contracting or transmitting HIV and other sexually transmitted infections.
• In women, TV may cause premature birth, or low birth weight in those who are pregnant.

Complications of Non-STI-related penile discharge:

These include, but are not limited to:

• Urethritis
• Kidney Infection and damage
• Urosepsis
• Urethral narrowing or stricture
• Prostatitis
• Balanitis

Dhat syndrome is a culture-bound syndrome most commonly found in South Asia (Pakistan, India, Bangladesh, Nepal and Sri Lanka). It’s considered a psychosexual problem as there is nothing usually physically wrong with the patient. This is thought to arise from feelings of anxiety over the cultural importance of fertility and the view of semen being seen as life’s most precious fluid.

The most commonly reported symptoms include premature ejaculation, impotence or anxiety that they are passing semen during urination. Patients may also report random generalised symptoms such as weakness and exhaustion.

Passing sperm in urine can be bewildering to the patients. Diagnosis can be made by demonstrating the presence of sperm in the urine by microscopy, and ruling out other infections by appropriate tests.