Penile Discharge Fact Sheet

Penile discharge is the abnormal loss of fluid that is not urine or semen from the urethra at the tip of the penis. It is commonly the sign of a sexually transmitted disease (STD), and requires prompt and accurate diagnosis and treatment.

The problem is that, while some STDs have clear symptoms and are easy to diagnose, others cause no symptoms at all. However, people carrying them can still transfer an STD to someone else. The latest research indicates that there are more than 25 diseases that could be spread through sexual contact. Most of them are curable but there are some that still cannot be cured.

Sexually Transmitted Diseases: Statistical Data

About 12 million new STD infections occur in the United States each year and, about 25% of those occur in people between the ages 16 and 19. One in five Americans or approximately 56 million people carry a sexually transmitted disease. Over 40 million people are estimated to have chronic genital herpes, and there are an estimated 4 million new Chlamydia cases a year. [1]

What Are The Symptoms Of Penile Discharge?

Penile discharge can vary in amount from scanty to profuse, and in color from clear to yellow or green. The timing of the discharge can also vary from early in the morning only, to throughout the day.

Discharge from the penis is often accompanied by other symptoms such as [2]:

• Burning on passing urine (dysuria)
• Frequent need to pass urine (frequency)
• Excessive need to urinate at night (nocturia)
• Rash in the genital area, which can be painful or itchy
• Swollen lymph nodes (glands) in the groin

The most common causes of penile discharge

A variety of causes can produce a persistent drip from the penis, but the vast majority of penile discharges are the result of sexually transmitted diseases. 

The two most common STDs that cause penile discharge are gonorrhea and chlamydia and they both have similar signs. 

The discharge may appear as soon as 2 to 5 days after having sex with an infected partner, or it could take as long as 14 days.

Another common cause is an infection or irritation of the urethra, a disease known as nonspecific urethritis. An infection or inflammation of the prostate called prostatitis may also prompt penile discharge. [3,4]

Conditions that produce some penile discharge can be divided into two big groups:

• Gonococcal
• Non-gonococcal  

Gonococcal Urethritis (Gonorrhea)

This sexually transmitted disease is caused by a bacterium called Neisseria gonorrhoeae. The incubation period usually lasts two to five days. The most common symptoms of this type of urethritis include purulent (pus-containing) discharge which peaks within two weeks. Discharge occurs in 95 percent of men and it is [4]:

• Purulent in 75 percent,
• White or cloudy in 10 percent and
• Clear in 5 percent

It can be easily transmitted by sexual intercourse, or other sexual activity, including oral sex. Because this condition can be spread by oral, anal, and vaginal sex, it is very difficult to prevent it just by using condoms. 

If gonorrhea is left untreated, it causes further complications. The infection can spread up the urethra to the epididymis and sometimes even cause infertility.

Non-Gonococcal Or Non-Specific Urethritis

Non-specific urethritis is the most common form of penile discharge. Researchers have come to the conclusion that men between 20 and 35 years of age are most commonly affected. Several different organisms can cause non-specific urethritis [5]:

• Chlamydia trachomatis
• Mycoplasma genitalium
• Ureaplasma urealyticum
• Trichomonas vaginalis
• Herpes simplex

Chlamydia trachomatis 

A bacterium called Chlamydia trachomatis causes this condition. The symptoms of Chlamydia are painful urination and watery discharge. Diagnosis is easy and it includes [3]:

• Inclusion bodies in Giemsa stain.
• Obligate intracellular bacteria.
• PCR

It is important to know that the patient may also be asymptomatic (show no symptoms) which represents an epidemiological threat. Therefore, if you suspect you might have (had) intercourse with a Chlamydia trachomatis infected person, get tested.    

Ureaplasma urealyticum

Ureaplasma urealyticum is an organism that causes a sexually transmitted disease characterized by painful urination and purulent discharge. Ureaplasma urealyticum causes approximately 20% of cases of non-gonococcal urethritis. It can produce urease unlike other Mycoplasmas.[6]

Genital Herpes

Genital herpes is a viral infection that causes periodic outbreaks of painful sores around the genitals. It is caused by the Herpes simplex virus which exists as two different viral types, HSV-1 and HSV-2.

• HSV-1 is the virus that causes cold sores.  
• HSV-2 is the virus that causes genital herpes, although you can be infected with HSV-1 and have sores in your genital area. 

Genital herpes can be spread even when using a condom, because the lesions can form in areas the condom does not cover. It is also possible to transmit herpes even when you do not have visible lesions. Since herpes is a viral condition, there is no cure for it. Antiviral medicines can be taken to reduce the number and severity of outbreaks and lessen the chance of asymptomatic viral shedding. 

The only possible ways of prevention are limiting the number of sex partners and use of condoms. Anyone who thinks they may be infected should avoid any sexual contact and contact an STD clinic. [7]

Trichomonas Vaginalis

Trichomoniasis is a common sexually transmitted disease caused by a tiny parasite called Trichomonas Vaginalis, also known as trich. It mostly infects the vagina, but occasionally it may infect the urethra in men. It is proven that using condoms correctly lowers the risk of catching trichomoniasis.[8]

On very rare occasions, this parasite can be spread by sharing moist towels, washcloths and hot baths. What are the symptoms of trichomonas vaginalis?

The most common symptoms in men include:

• Penile discharge.
• Pain when passing urine.

But infection with trich can also be asymptomatic.

How is trichomonas vaginalis diagnosed? The doctor usually examines the patient’s genital area, and a sample may be taken from the vagina or urethra using a cotton wool swab. Complications with trichomoniasis are rare. If a woman is infected when she gives birth, she may pass it on to the baby.[8]

Most common bacterial STD's

Diagnosis Of Conditions Accompanied By Penile Discharge

There are several different ways to diagnose an STD. Penile discharge urethritis is most commonly diagnosed by finding white blood cells on a urethral swab or urine sample. The color and consistency of the discharge alone does not help distinguish any non-specific urethritis from gonococcal urethritis. [5]

Gonococcal urethritis is diagnosed in 98% of men by microscopic examination of the discharge obtained from a urethral swab.
Development of more sensitive tests such as polymerase chain reaction and ligase chain reaction might allow for more precise diagnosis, especially in patients with no symptoms. [5] 

Treatment Of Conditions With Penile Discharge

Gonococcal urethritis

One of several antibiotics can be given as a single dose [5]:

• Ceftriaxone 250mg by intramuscular injection
• Cefixime 400mg orally
• Ciprofloxacin 500mg orally
• Ofloxacin 400mg orally.
• Doxycycline 100mg twice daily for seven days

Non-specific urethritis 

Typical antibiotic treatment includes doxycycline 100mg twice daily for seven days or a single dose of Azithromycin 1g if the infection is due to Chlamydia trachomatis. [5]

Prevention Of STDs

The most secure way of preventing sexually transmitted diseases is definitely sustaining from sexual intercourse. Another option is to be in a long-term monogamous relationship with an uninfected partner. 

Activities that carry a very low or no risk of developing a sexually transmitted disease are:

• Kissing
• Massage
• Masturbation
• Sexual stimulation using your hand on another person
• Oral sex on a man who is wearing a condom
• Oral sex on a woman who is wearing a dental dam or plastic wrap