What is penile discharge? We look at the common symptoms and treatment
Concerned about unexpected penile discharge? If you experience abnormal fluid leaking from your penis, you might be understandably alarmed. While semen and urine are perfectly normal, penile discharge is often the result of a bacterial, viral or yeast infection and is usually a sign that something is amiss, so it is worth getting checked out.
Male sexual health specialist Dr Geoff Hackett looks at the symptoms, causes and treatment options for penile discharge:
What is penile discharge?
Penile discharge is any substance that comes from the urethra (urine tube) at the tip of the penis that is not urine or semen.
Discharge from the penis is commonly the sign of a sexually transmitted infection (STI), and it requires prompt and accurate diagnosis and treatment, usually by staff at a specialist sexual health clinic.
Penile discharge symptoms
Penile discharge can vary in amount from scanty to profuse and in colour from clear to yellow or green. The timing can vary from loss in the morning only to throughout the day.
Penile discharge is often accompanied by other symptoms, including the following:
Dysuria: burning on passing urine.
Frequency: frequent need to pass urine.
Nocturia: excessive need to urinate at night.
Rash: a rash in the genital area can be painful or itchy.
Swollen glands: swollen lymph nodes in the groin.
If you experience watery, clear, opaque or cloudy discharge and it contains pus or blood, make an urgent appointment with your GP or local sexual health clinic.
Penile discharge causes
Common causes of penile discharge include non-gonococcal or non-specific urethritis (NSU) and gonococcal urethritis.
Non-gonococcal or non-specific urethritis (NSU)
NSU is the most common form of penile discharge, accounting for over 60,000 new cases per year in England alone. Men aged between 20 and 35 years are most commonly affected.
Several different organisms (bugs) can cause the syndrome:
Chlamydia trachomatis - 25 to 60 per cent.
Mycoplasma genitalium - up to 25 per cent.
Ureaplasma urealyticum - 15 to 25 per cent.
Trichomonas vaginalis - 17 per cent.
Herpes simplex - rarely.
Routine tests are not available to detect all of these infections, so the cause of the NSU might not be found. In some patients, no sexual contact has occurred and the symptoms are blamed on irritants, soaps or detergents. But no firm evidence exists to support this theory.
Gonococcal urethritis (gonorrhoea)
If you have contracted gonorrhoea, also known as the clap, this is caused by Neisseria gonorrhoeae.
Gonorrhoea incubation period: it usually takes two to five days from infection to symptoms. Without treatment, symptoms of urethritis (inflammation of the urethra) and purulent (pus-containing) discharge peak within two weeks.
Gonorrhoea symptoms: discharge occurs in 95 per cent of men and is purulent in 75 per cent, white or cloudy in 10 per cent and clear in 5 per cent. Recent urination can make the discharge appear less purulent. When the infection begins to resolve, the discharge changes from purulent to mucoid (mucus-like).
Gonorrhoea transmission: transmitted by sexual intercourse, including oral sex. Without treatment, the infection can continue for many months.
Gonorrhoea complications: spread up the urethra to the epididymis (sperm-storing tube connected to the testicles) is rare and infertility can be a rare late complication. Anal infection is common especially, but not only, when the infection is transmitted by anal intercourse. Bloodstream infection occurs in less than 1 per cent of patients, causing arthritis of the knees, wrists and hands plus fever, chills and skin lesions, usually papules or pustules (red or pus-containing raised spots or bumps) on the hands or feet.
If you have any of the symptoms of gonorrhoea or you think you may have an STI, visit your local sexual health clinic for an STI test.
Penile discharge diagnosis
Penile discharge or urethritis is diagnosed by finding white blood cells (neutrophils or pus cells) on a urethral swab or 'first catch' urine sample (ie urine taken from when you first begin to pass water). The infecting organism might be identified from these samples.
Ideally, the patient should be seen in a sexual health clinic for prompt examination of specimens because transfer of specimens to a hospital laboratory can lead to a missed diagnosis.
The colour and consistency of the discharge does not help to distinguish NSU from gonococcal urethritis. Gonococcal urethritis is diagnosed in 98 per cent of men by microscopic examination of the discharge obtained from a urethral swab.
Other infections are less easily diagnosed. Between 6 and 11 per cent of sexually active UK men carry chlamydia in their urethra with minimal or no symptoms.
The development of more sensitive tests, such as polymerase chain reaction and ligase chain reaction, might allow for more precise diagnosis, particularly in patients with no symptoms and especially if they are sexual contacts of proven infected women. But this is not used routinely in STI clinics.
Penile discharge treatments
Depending on the cause, a course of antibiotics is usually the first point of defence for penile discharge:
Gonococcal urethritis
One of several antibiotics can be given as a single dose:
Ceftriaxone - 250mg by intramuscular injection
Cefixime - 400mg orally
Ciprofloxacin - 500mg orally
Ofloxacin - 400mg orally.
In addition, doxycycline 100mg twice daily for seven days is often given to treat chlamydia in case it is present. Sexual partners are given similar treatment.
NSU
Usual antibiotic treatment includes doxycycline 100mg twice daily for seven days or a single dose of azithromycin 2g as a single dose if the infection is due to Chlamydia trachomatis, according to the British Association for Sexual Health and HIV (BASHH) guidelines.
Sexual partners should be given similar treatment. Patients should be followed up after two weeks with repeat swabs (known as 'test of cure') because of the high risk of re-infection often due to failure of all sexual partners to comply with therapy.
Contact tracing
It is essential that sexual contacts of men with gonococcal urethritis and NSU are traced and treated, preferably at an STI clinic. Without treatment of sexual contacts, recurrence is likely and treatment will probably fail.
Pregnant or potentially pregnant sexual partners should not be given erythromycin or tetracycline antibiotics (including doxycycline).
Conventional therapy for NSU fails in 25 per cent of cases. Longer courses of antibiotics have not been shown to be of benefit and re-infection from a new or untreated partner is the usual cause.
It's important to realise that recurrence of NSU can cause considerable psychological strain on individuals and relationships, and it's important that both partners in a relationship have a full explanation and understanding of the nature of the condition.
Sexual health services
If you are concerned you might have a sexually transmitted infection, always get checked out. Contact your local sexual health clinic on the details below, or speak to your GP.
Find a sexual health clinic near you.
Find contraceptive services near you.
Call the National Sexual Health Line 0300 123 7123.
Call Worth Talking About on 0300 123 2930 (for under-18s).
Last updated: 28-06-2020
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