1. Q: What could his symptoms be due to?
Case Study
Ms. T. does not know which partner she got chlamydia from and wonders if it could be her current partner. He has complained on and off of some urethral irritation with occasional clear discharge.
Q: What could his symptoms be due to?

2. Urethral Discharge & Irritation
Urethral discharge (UD) is a common symptom with etiology varying from sexually transmitted infection (STI) to cancer.
Urethral Irritation often accompanies UD.

3. Etiology STI’s Infections: cystitits, prostatitis
Anatomic & Congenital Abnormalities: urethral stricture, phimosis
Iatrogenic: catheterization, instrumentation, other procedures
Tumours
Foreign Bodies

4. Etiology
Substance Abuse: chronic use of amphetamines and stimulants produce serous discharge; caffeine, alcohol use
Miscellaneous Factors: sexual practices, masturbation, oral sex
Unknown: no organisms may be found in up to 1/3 of patients

5. Sexually Transmitted Infections
Several STI’s have UD as part of their clinical manifestations.
Mr. T may have an STI.
The following STI’s are characterized by UD.
Gonnorhea
Chlamydia
Trichomoniasis

6. Gonnorhea
60% of men infected suddenly experience marked dysuria and spontaneous, profuse, mucopurulent discharge from the urethra.
some individuals have little discharge or urethral itching only
5% to 10% never have signs or symptoms

7. Chlamydia
Chlamydial infection accounts for 50% to 60% of cases of NGU (Nongonococcal urethritis) in men.
Men might note a clear, mucous discharge on rising in the morning; dry, clear discharge on their underwear; or mild burning with urination.

8. Gonorrhea VS. Chlamydia
Urethritis caused by gonorrhea and chlamydia cannot be differentiated: both have a 7- to 21-day incubation period and cause dysuria.

9. Gonorrhea VS. Chlamydia
Chlamydial urethritis is generally milder than gonorrheal urethritis and more likely to be asymptomatic. Symptoms may be intermittent or unnoticeable.
Urethral discharge in men may be similar in the two infections, chlamydial discharge tends to be more clear and gonococcus discharge more purulent.

10. Trichomoniasis Most men with trichomoniasis remain asymptomatic.
Possible clinical manifestations include scant intermittent discharge, slight pruritus, and mild dysuria.

11. Urethritis & Prostatitis
Mr. T’s urethral discharge and urethral irritation may be caused by urethritis or prostatitis.

12. Urethritis Inflammation of the urethra Ascending infection in men
Associated with cystitis and vaginitis in women
Usually asymptomatic
S&S: Itching, burning around urethra, UD (scant to profuse, thin, clear or mucoid, thick or purulent) dysuria and frequency, penile discomfort

13. Urethritis Causes Include: Nongonococcal urethritis
STI: gonnorrhea, chlamydia, trichomonas, HSV,
Bacterial urethritis r/t UTI
Trauma

14. Prostatitis Inflammation of the prostate gland
Classified as acute or chronic bacterial prostatitis OR non-bacterial prostatitis

15. Prostatitis acute bacterial prostatitis: fever, chills, body aches
chronic and non-bacterial prostatitis: symptoms more subtle: bladder irritability (frequency, dysuria, nocturia, urgency, hesitancy, hematuria) pain (rectum, perineum, lower back and abdomen, penile head)

16. Acute or Chronic Bacterial Prostatitis
Causes Include:
Reflux of infected urine into ejaculatory and prostatic ducts
Hematogenous
Secondary to urethritis
Urethral instrumentation
Pseudomonas, e.coli, klebsiella, streptococcus, staphylococcous, chlamydia

17. Non-Bacterial Prostatitis
Causes Include:
Trichomonas, ureaplasma or other organism
Prostatodynia: pain/discomfort without other signs of infection and no identifiable causative factor

18. Q: What could his symptoms be due to?
Case Study
Ms. T. does not know which partner she got chlamydia from and wonders if it could be her current partner. He has complained on and off of some urethral irritation with occasional clear discharge.
Q: What could his symptoms be due to?

19. Case Study
Mr. T’s symptoms – urethral irritation with occasional clear discharge – are mostly likely due to:
Chlamydia
Trichomonas
Urethritis (gonococcal or nongonococcal)

20. How would you respond to Ms. T?
Case Study
How would you respond to Ms. T?
If Mr. T was your client presenting with these complaints, what data would you collect? What investigations would you order?

21. References
Lippincott Manuel of Nursing Practice (8th ed.) (2006) S.M. Nettina (Ed.). Lippincott, Williams & Wilkins: Philadelphia.
McCance, K.L., & Huether, S.E. (2006). Pathophysiology: The biological basis for disease in adults and children (5th ed.). St.Louis, MI: Elsevier Mosby.
Samraj, G.P.N. (2006). Urethral Discharge. In Paulman, P.M., Paulman, A.A., & Harrison, J.D. (eds.), Taylor's 10-minute diagnosis manual: Symptoms and signs in the time-limited encounter (2nd ed.). Lippincott, Williams & Wilkins: Philadelphia.