GuidelinesEML (Adult Hospital STG)
Male Urethritis Syndrome (MUS)
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults 2019 Edition
These guidelines apply to patients who are referred from primary healthcare centres for further investigation and management of PERSISTENT STI symptoms or syndromes that have not improved or resolved and are still present 7 days after administration of standard first-line syndromic therapy. |
A64 + N34.1
- Male urethritis/ visible urethral discharge that persists despite appropriate syndromic management should be investigated for suspected cefriaxone-resistant gonorrhea.
- Referral letter from PHC should include all relevant information (including HIV status, treatment history and partner notification and management).
INVESTIGATIONS
- It is essential to confirm ceftriaxone-resistant gonorrhea.
- All NHLS standard laboratory forms must include the following information:
- Name and contact details (cellphone number + email address) of requesting healthcare worker.
- Genital specimen collection and test requests (to confirm presence of any STI pathogens and if Neisseria gonorrhoeae present, and determine ceftriaxone susceptibility):
- Materials: Two Dacron swabs (wire shaft, slender tip); Amies transport medium (all obtained from local NHLS laboratory).
- Urethral swab 1: Gently insert 2 cm into the urethral meatus, and rotate for 5-10 seconds. Place this swab immediately into Amies transport medium.
- Test request: Transport on ice to local NHLS laboratory as soon as possible, preferably within 24 hours for Neisseria gonorrhoeae culture and sensitivity testing. (Contact laboratory for directions on transport of specimens).
- Presumptive diagnosis: Persistent urethritis die to possible ceftriaxone-resistant gonorrhea.
- Urethral swab 2: Gently insert 2 cm into urethral meatus, and rotate for 5-10 seconds. Place in a sterile universal container or tube, cut of the wire shaft and close the container.
- Test request: Transport on ice to NICD STI reference laboratory as soon as possible for PCR genital discharge pathogens.
- Presumptive diagnosis: Persistent urethritis due to possible ceftriaxone-resistant gonorrhea.
- Materials: Two Dacron swabs (wire shaft, slender tip); Amies transport medium (all obtained from local NHLS laboratory).
MEDICINE TREATMENT
Persistent urethral discharge after 7 days confirmed on examination, pending results:
- Cefriaxone, IM, 1 000 mg immediately as a single dose.
LoE:III1
- Dissolve ceftriaxone 1 g in 3.6 mL lidocaine 1% without adrenaline (epinephrine).
LoE:III2
AND
- Azithromycin, oral, 2 g as a single dose.
LoE:III3
Severe penicillin allergy: Z88.0
- Gentamicin, IM, 6 mg/kg, IM as a single dose. (See Prescribing Information for Specific Medicines for Guidance on prescribing).
AND
- Azithromycin, oral, 2 g as a single dose.
LoE:III4
Ask patient to return in two weeks for follow-up of laboratory results and further clinical evaluation. Treat accordingly.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults 2019 Edition