What is the treatment for a man with yellow penile discharge, likely due to gonorrhea (Neisseria gonorrhoeae) or chlamydia (Chlamydia trachomatis)?

From the Guidelines

The recommended treatment for a man with yellow penile discharge likely due to gonorrhea or chlamydia is dual antibiotic therapy, specifically a single intramuscular injection of ceftriaxone 250mg plus oral azithromycin 1g or doxycycline 100mg twice daily for 7 days, as recommended by the most recent guidelines 1.

Key Considerations

• The choice of antibiotic regimen should be based on the most recent guidelines and susceptibility patterns.
• Dual therapy is recommended to address both gonorrhea and chlamydia, as co-infection is common.
• Ceftriaxone is the preferred cephalosporin due to its efficacy and safety profile.
• Azithromycin or doxycycline can be used as the second component of dual therapy, with azithromycin being a single-dose option and doxycycline requiring a 7-day course.

Treatment Regimens

• Ceftriaxone 250mg IM plus azithromycin 1g orally as a single dose
• Ceftriaxone 250mg IM plus doxycycline 100mg orally twice daily for 7 days

Additional Recommendations

• Patients should abstain from sexual activity until treatment is completed and symptoms resolve, typically within 7-10 days.
• All recent sexual partners (within the past 60 days) should be notified, tested, and treated to prevent reinfection.
• Follow-up testing is recommended 3 months after treatment to ensure cure.

Rationale

The dual therapy approach is effective because ceftriaxone targets the cell wall of Neisseria gonorrhoeae, while azithromycin or doxycycline inhibits protein synthesis in both organisms, particularly Chlamydia trachomatis, ensuring comprehensive coverage of the most likely pathogens causing the symptoms 1.

From the FDA Drug Label

Uncomplicated gonococcal infections in adults (except anorectal infections in men):100 mg, by mouth, twice a day for 7 days. As an alternate single visit dose, administer 300 mg stat followed in one hour by a second 300 mg dose. Uncomplicated urethral, endocervical, or rectal infection in adults caused by Chlamydia trachomatis: 100 mg, by mouth, twice a day for 7 days. Urethritis and cervicitis due to Chlamydia trachomatis or Neisseria gonorrhoeae.

The treatment for a man with yellow penile discharge, likely due to gonorrhea (Neisseria gonorrhoeae) or chlamydia (Chlamydia trachomatis), is:

• Doxycycline 100 mg, by mouth, twice a day for 7 days 2
• Azithromycin may also be used, but the dosage is not specified in the label for gonorrhea, however for chlamydia it is a single dose of 1g 3

From the Research

Treatment for Yellow Penile Discharge

The treatment for a man with yellow penile discharge, likely due to gonorrhea (Neisseria gonorrhoeae) or chlamydia (Chlamydia trachomatis), typically involves antibiotics.

• A single intramuscular injection of ceftriaxone, 250 mg, is first-line treatment for uncomplicated urogenital, anorectal, or pharyngeal gonococcal infections 4.
• However, recent guidelines recommend a single 500 mg IM dose of ceftriaxone for treatment of uncomplicated urogenital, anorectal, and pharyngeal gonorrhea 5.
• If chlamydial infection has not been excluded, concurrent treatment with doxycycline (100 mg orally twice a day for 7 days) is recommended 5, 6.
• Azithromycin may be used as an alternative treatment option for patients with previous allergic reactions to penicillin, but its use should be limited due to the likelihood of antimicrobial resistance 4, 7.

Diagnosis and Testing

• Urogenital N. gonorrhoeae infection can be diagnosed using culture or nucleic acid amplification testing 4.
• Urine nucleic acid amplification tests have a sensitivity and specificity comparable to those of cervical and urethral samples 4.
• A diagnosis of urethritis can be made if at least one of the following is present: discharge, a positive result on a leukocyte esterase test in first-void urine, or at least 10 white blood cells per high-power field in urine sediment 8.

Prevention and Follow-up

• Gonococcal infection should prompt physicians to test for other sexually transmitted infections, including human immunodeficiency virus 4.
• Patients should be retested in three to six months due to high reinfection rates 4.
• Condom use is an effective strategy to reduce the risk of infection 4.
• Expedited partner treatment, which involves giving patients prescriptions for partners who have not been examined by the physician, is advocated by the Centers for Disease Control and Prevention and has been approved in many states 8.