Algorithm Mkacs

Men presenting with penile discharge and dysuria Patient sexually active If proximal-to-distal “milking” of the urethra does not express a purulent or mucopurulent discharge, even after the patient has not voided for several hours (or preferably overnight) Gram’s-stained smear of an anterior urethral specimen obtained by passage of a small urethrogenital swab 2–3 cm into the urethra

Associated with unilateral, painful, with swelling, and tenderness of the epididymis, with or without symptoms or signs of urethritis.

Evaluate for complications or alternative diagnoses. men with dysuria who lack evidence of urethritis as well as sexually inactive men with urethritis should undergo prostate palpation, urinalysis, and urine culture to exclude bacterial prostatitis and cystitis.

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reveals ≥2 neutrophils per 1000× field

Ceftriaxone (250 mg IM single dose) followed by Doxycycline (100 mg BID for 10 days) Levofloxacin (500 mg OD for 10 days) or ofloxacin (300 mg twice daily for 10 days – for Enterobacteriaceae (If confirmed)

URETHRITIS present

Positive smear usually reveals gram-negative intracellular diplococci

Penile lesions

Negative

Painful vesicles

Gonococcal urethritis

Non-gonococcal urethritis

POSITIVE for gonorrhea or no diagnostic done: • Single dose regimen for gonorrhea plus azithromycin or doxycycline (coinfection)

NEGATIVE for gonorrhea: • Azithromycin (1g single dose), or Doxycycline (100mg BID for 7 days) • Azithromycin has better result with M. genitalium

SEXUAL PARTNER SHOULD BE TESTED AND RECEIVE SAME REGIMEN GIVEN TO THE MALE

Ulcer Chancroid, syphilis or LGV

Herpes

REFERENCES: • •

Jameson, J. L. (2018). Harrison's principles of internal medicine. McGraw-Hill Education. Michels, T. C., & Sands, J. E. (2015, November 1). Dysuria: Evaluation and differential diagnosis in adults. American Family Physician. Retrieved September 13, 2021, from https://www.aafp.org/afp/2015/110 1/p778.html.