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?
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.
Etiology
STI’s
 Infections: cystitits, prostatitis
 Anatomic & Congenital Abnormalities:
urethral stricture, phimosis
 Iatrogenic: catheterization,
instrumentation, other procedures
 Tumours
 Foreign Bodies

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

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
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

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.

Gonorrhea VS. Chlamydia

Urethritis caused by gonorrhea and
chlamydia cannot be differentiated: both
have a 7- to 21-day incubation period and
cause dysuria.
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.

Trichomoniasis
Most men with trichomoniasis remain
asymptomatic.
 Possible clinical manifestations include
scant intermittent discharge, slight
pruritus, and mild dysuria.

Urethritis & Prostatitis
Mr. T’s urethral discharge and urethral
irritation may be caused by urethritis
or prostatitis.
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

Urethritis
Causes Include:
Nongonococcal urethritis
 STI: gonnorrhea, chlamydia, trichomonas,
HSV,
 Bacterial urethritis r/t UTI
 Trauma

Prostatitis

Inflammation of the prostate gland

Classified as acute or chronic bacterial
prostatitis OR non-bacterial prostatitis
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)

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
Non-Bacterial Prostatitis
Causes Include:
 Trichomonas, ureaplasma or other
organism
 Prostatodynia: pain/discomfort without
other signs of infection and no identifiable
causative factor
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?
Case Study
Mr. T’s symptoms – urethral irritation with
occasional clear discharge – are mostly
likely due to:
 Chlamydia
 Trichomonas
 Urethritis (gonococcal or nongonococcal)
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?
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.