Male Urethritis Syndrom (MUS)

A64 + N34.1

Male urethritis/ visible urethral discharge that persists despite appropriate syndromic management should be investigated for suspected ceftriaxone-resistant gonorrhea. Referral letter from PHC should include all relevant information (including HIV status, treatment history and partner notification and management).

INVESTIGATIONS

  • It is essential to confirm ceftriaxone-resistant gonorrhea.
  • All NHLS standard laboratory forms must include the following information:
    • Name and contact details (cellphone number + email address) of requesting healthcare worker.
  • Genital specimen collection and test requests (to confirm presence of any STI pathogens and if Neisseria gonorrhoeae present, and determine ceftriaxone susceptibility):
    • Materials: Two Dacron swabs (wire shaft, slender tip); Amies transport medium (all obtained from local NHLS laboratory).
      • Urethral swab 1: Gently insert 2cm into the urethral meatus, and rotate for 5-10 seconds. Place this swab immediately into Amies transport medium.
      • Test request: Transport on ice to local NHLS laboratory as soon as possible, preferably within 24 hours for Neisseria gonorrhoeae culture and sensitivity testing. (Contact laboratory for directions on transport of specimens).
      • Presumptive diagnosis: Persistent urethritis due to possible ceftriaxone-resistant gonorrhea.
      • Urethral swab 2: Gently insert 2cm into urethral meatus, and rotate for 5-10 seconds. Place in a sterile universal container or tube, cut off the wire shaft and close the container.
      • Test request: transport on ice to NICD STI reference laboratory as soon as possible for PCR genital discharge pathogens.
      • Presumptive diagnosis: Persistent urethritis due to possible ceftriaxone-resistant gonorrhea.

MEDICINE TREATMENT

Persistent urethral discharge after 7 days confirmed on examination, pending results:

  • Ceftriaxone, IM, 1 000 mg immediately as a single dose. LoEIII [1]
    • Dissolve ceftriaxone 1 g in 3.6 mL lidocaine 1% without adrenaline (epinephrine).

LoEIII [2]

AND

  • Azithromycin, oral, 2 g as a single dose.

LoEIII [3]

Severe penicillin allergy: Z88.0

LoEIII [4]

AND

  • Azithromycin, oral, 2 g as a single dose.

Ask patient to return in two weeks for follow-up of laboratory results and further clinical evaluation. Treat accordingly.