Discharge from the penis is a continuous or intermittent flow of fluid from the urethra. Ask the patient whether he has ever had a discharge and, if he has, whether it was bloody or purulent. Bloody penile discharges are associated with ulcerations, neoplasms, or urethritis. Purulent discharges are thick and yellowish-green and may be associated with gonococcal urethritis or chronic prostatitis. Determine when the discharge was first noted. Figure 18-7 shows a purulent penile discharge in a man with gonococcal urethritis. Gonorrhea is caused by Neisseria gonorrhoeae. After exposure, approximately 25% of men and more than 50% of women contract the disease. In men, the acute symptoms of dysuria and a purulent urethral discharge begin 2 to 10 days after exposure. In women, a vaginal discharge and dysuria develop days to weeks after exposure;however, in up to 50% of women, the infection may be asymptomatic.
Tactful direct questioning about any history of or exposure to sexually transmitted diseases is essential. The interviewer should determine the patient's sexual orientation and the type of sexual exposure—oral, vaginal, or anal—because this information can help determine the types of bacteriologic cultures necessary. It is appropriate to ask whether the patient has more than one sexual partner and whether the partner or partners have any known illnesses. The sexual history questions suggested in Chapter 1, The Interviewer's Questions, may be helpful.
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