Gonococcal Urethritis , Tulo

A 30 year old male, married, taxi driver came to the clinic complaining of pain with urination and noticeable increase in frequency of 3 days duration. He also noted a yellowish green copious penile discharge that often leaves stain in his underwear. He also said that he had a slight fever and took Paracetamol 500mg which relieved the symptom. On further prodding , the patient volunteered that he had unprotected sex with a sex worker in a bar in Pasay City a week prior to consultation.
History,laboratory and physical examination points to a diagnosis of Urethritis, most probably Gonococcal(Tulo),Gonorrhea, in etiology. Patient was given Azythromycin 1gm as a single dose together with Cefixime 200mg, 2 tablets as single dose. Patient was also advised to increase fluid intake and to practice safe sex in the future.
Gonococcal Urethritis, Tulo, is a sexually transmitted disease with an incubation period of 2-7 days, that causes urinary symptoms like frequency,urgency and dysuria.Almost always there is a copious ,green, yellow urethral discharge that often leaves a mark in the underwear thus the local term "Tulo" or drip . The penile opening or meatus and the anterior urethra may also be inflammed thus a patient may experience a burning sensation with the passage of urine.
Gonorrhea also called the clap, which is caused by Neisseria gonorrhoeae, is an important public health problem and is the most common reportable infectious disease. Gonorrhea is most frequently spread during sexual contact. The most common local complication of gonorrhea in men is Epididymitis which causes unilateral testticular pain and swelling, and epididymal tenderness. Urethral dischage may or may not be present.




(image courtesy www.cdc.gov)

Photos and Images compiled from Google.com

Penile Discharge "Tulo"

A 24 year old, male, married, OFW, visited the clinic for a light yellow discharge coming out of his penis for the past 3 days, staining his underwear, he also complains of pain during urination. He admitted having sexual intercourse with a prostitute about 5 days before symptoms appeared. He is scheduled to depart for the Middle East in 3 days.
After physical examination and confirming the creamy penile discharge, with no laboratory test and no possibility of follow up, I gave the following meds.
1) Doxycycline 100mg tab. 2 tablets initially then 1 tablet every 12 hours(2xday) for 10 days plus
2) Cefixime 200mg Tab , 1 tab every 12 hours for 5 days

Gonococcal urethritis (check my latest blog on GC Urethritis,"Tulo" here -http://wazzupdok.blogspot.com/2010/12/tulo-or-gonococcal-urethritis.html

Gonorrhoea is caused by the bactterium Neisseria gonorrhoeae that grow and multiply in the reproductive tract of women(cervix ,uterus, fallopian tubes) and men (urethra). The bacteria can also multiply in eyes, mouth, throat and anus.

Incubation period usually takes two to five days from infection to symptoms and without treatment,the symptoms of urethritis (inflammation of the urethra) and purulent (pus-containing) discharge peak within two weeks.

Most notable symptom is the penile discharge which occurs in 95 per cent of men and is purulent in 75 per cent, white or cloudy in 10 per cent and clear in 5 per cent. Recent urination can make the discharge appear less purulent. When the infection begins to resolve, the discharge changes from purulent to mucoid (mucus-like).

Transmission of the disease is usually by sexual intercourse, including oral sex and without treatment, the infection can continue for many months.

Complications can occur and spread up the urethra to the epididymis (sperm-storing tube connected to the testicles) but is rare and infertility can be a rare late complication. Anal infection is common especially, but not only, when the infection is transmitted by anal intercourse. Bloodstream infection occurs in less than 1 per cent of patients, causing arthritis of the knees, wrists and hands plus fever, chills and skin lesions, usually papules or pustules (red or pus-containing raised spots or bumps) on the hands or feet.

Reminder: Article was written as a physician's personal experience and should be viewed for information and guide only, and was not intended to replace actual consultation with a medical practitioner.

Photos and Images compiled fromGoogle.com