Differential Diagnosis for a 31-year-old Male with Urethral Discharge and Dysuria
- Single most likely diagnosis:
- Gonococcal urethritis: This is the most likely diagnosis due to the symptoms of urethral discharge and dysuria, which are classic presentations of a gonococcal infection. The patient's age and sexual history also increase the likelihood of this diagnosis.
- Other Likely diagnoses:
- Chlamydial urethritis: Similar to gonococcal urethritis, chlamydial infections can cause urethral discharge and dysuria. Chlamydia is a common sexually transmitted infection (STI) that can present with these symptoms.
- Non-gonococcal urethritis (NGU): This condition, often caused by Mycoplasma genitalium or Ureaplasma urealyticum, can also lead to urethral discharge and dysuria, although the discharge may be less pronounced than in gonococcal infections.
- Trichomoniasis: Although less common in men, Trichomonas vaginalis infection can cause urethral discharge and dysuria, especially if the patient has had unprotected sexual contact with an infected partner.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Reiter's syndrome: A form of reactive arthritis that can occur after certain bacterial infections, including chlamydia. It's crucial to consider this diagnosis due to its potential for severe complications if left untreated.
- Urethral stricture: Although less likely, a urethral stricture could cause obstructive symptoms that might be mistaken for dysuria. This condition requires prompt diagnosis and treatment to prevent long-term complications.
- Rare diagnoses:
- Urethral cancer: Extremely rare, but could present with symptoms of urethral discharge and dysuria. Given its rarity and potential severity, it's essential to keep this diagnosis in mind, especially if other causes have been ruled out.
- Genital herpes: While primarily known for causing genital ulcers, herpes simplex virus (HSV) infection can occasionally cause urethral discharge and dysuria, especially during the initial outbreak.