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When any discharge comes from the penis unintentionally, the first thought that crosses a physician's mind will be some type of underlying sexually transmitted disease that could be at fault. This is due chiefly to the fact that in every year in the world, there are 60 million new cases of just gonorrhea infections annually.  Most of these bacterial infections reside in the urethra (the tube that connects your bladder to your penis). When there is any inflammation in the urethra, penile discharge is common.

These patients will be worked-up for infections from N.gonorrheae and Chlamydia trachomatis, two of the most common organisms and also the main representatives of gonorrheal and nongonorrheal infections. The discharge that is typically seen when patients have N. gonnorheae infections is foul-smelling and will be dark brown in color. Infections from Chlamydia may be more sweet-smelling and will be light yellow in color.  

These men will require urinary cultures and PCR amplification testing to determine what specific bacteria is possible. Even in modern medicine, these tests are not perfect and men may find that they have culture-negative results.  A nucleic acid amplification test (NAAT) is commonly done to diagnose the presence of Chlamydia and N. gonorrheae but it only has a positive predictive value in 90 percent of cases. This means that if a test comes back positive, there is a 90 percent chance that you have the disease. Unfortunately, 10 percent of the tests can be inaccurate and some may even be negative even if the patient does suffer from the disease. In most cases, physicians will play the law of probability and prescribe treatments that are appropriate for those where cultures were positive. 

These sexually transmitted infections are diseases of society and are most likely to be seen in populations that are highly active sexually. In the United States, this group is generally those from the age of 15 to 30 but infections are possible outside this range. It is possible to have sexual transmitted infections from birth depending on prenatal care. Mothers can pass diseases to neonatal patients as they pass through the vaginal canal and although prenatal care has improved substantially in the last few decades, a nationalized standard of care was lacking beforehand and many adults in their 40s and 50s may be suffering from these infections without a history of risky sexual practice.

Just because you may have penile discharge, however, that does not mean that you do suffer from some type of sexually transmitted infection. It is possible to have discharge after infections from adenovirus, cytomegalovirus (CMV), mycobacterium or other less common infections. The ones I have listed here are common when patients have some type of lung or sinus infection so it is pivotal for you to remember what your health status was when you last had the episode of penile discharge. 

Discharge is even possible when there is local clogging of mucous glands inside of the urethra.Your body will secrete additional mucous to try to unclog these glands and can be seen in cases of poor penile hygiene. 

The most important thing to do when you first have penile discharge is to make an appointment with your urologist to have a better idea of what is the underlying cause. Safe sexual practices with condom use during intercourse reduces the likelihood of obtaining such an infection and adequate work-up can determine if this discharge can be from something less sinister like a simple lung infection.

It is also wise to encourage partners to get tested as well. Common bacteria like T. vaginalis are found in the vaginal canal in women but can be passed to men during sexual intercourse any time a condom is not used. This may result in penile discharge with a fishy-odor. Discharge will continue unless both parties are treated adequately. 

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