What is the typical color of genital discharge in gonorrhea compared with chlamydia?

Discharge Color in Gonorrhea and Chlamydia

Gonorrhea typically produces purulent (yellow-green) discharge, while chlamydia causes mucopurulent (white to yellow) discharge, though both infections are frequently asymptomatic and discharge characteristics alone cannot reliably distinguish between them.

Gonorrhea Discharge Characteristics

• Gonorrhea causes purulent discharge that is typically thick and yellow-green in color, particularly in symptomatic men with urethritis 1
• Men with gonorrhea commonly present with penile discharge and dysuria, though the discharge is often more profuse and purulent compared to chlamydia 1
• Women with gonorrhea may present with mucopurulent discharge, though many remain asymptomatic 1

Chlamydia Discharge Characteristics

• Chlamydia produces mucopurulent discharge that ranges from white to yellow in color 2, 3
• Mucopurulent cervicitis (MPC) is characterized by a yellow endocervical exudate visible in the endocervical canal or on swab specimens 2
• Women with chlamydial infections may experience abnormal vaginal discharge, though symptoms are often absent or mild 3
• In men, chlamydial urethritis causes urethral discharge that is typically less profuse than gonorrhea, with symptoms often being mild or absent 2

Critical Clinical Pitfalls

• Discharge characteristics are unreliable for diagnosis - both infections frequently present asymptomatically, and when discharge is present, there is substantial overlap in appearance 2, 3
• The absence of discharge does not exclude infection - asymptomatic infection is common in both men and women with either pathogen 2, 3
• Most women with chlamydia or gonorrhea do not have mucopurulent cervicitis - MPC is not a sensitive predictor of infection 2
• Many women with tubal-factor infertility from chlamydia never had symptoms severe enough to prompt treatment 2

Diagnostic Approach

• Never rely on discharge color alone for diagnosis - specific testing with nucleic acid amplification tests (NAATs) is required for both infections 2
• Test for both gonorrhea and chlamydia simultaneously, as coinfection rates are high (20-40% in some populations) 2, 4
• In symptomatic patients with discharge, empiric treatment for both infections should be initiated while awaiting test results if follow-up is uncertain 2
• Testing should be performed on cervical, urethral, or urine specimens using NAATs, which have superior sensitivity compared to culture 2

Treatment Implications

• Dual therapy is essential - patients treated for gonorrhea must also receive treatment effective against chlamydia due to high coinfection rates 2, 4
• Failure to treat concurrent chlamydia in patients with gonorrhea results in 83% microbiological failure for chlamydia 4
• Current first-line treatment is ceftriaxone 250 mg IM for gonorrhea plus azithromycin or doxycycline for chlamydia 1, 5