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?

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

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?

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

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?

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.