Morning Urethral Discharge: When to Seek Medical Advice

In the morning, there is pressure at the urethral opening with clear discharge?

Hello Dr.
Lee:
1.
Upon waking up in the morning and before urination, I notice a small amount of clear discharge (similar to clear glue) when I squeeze my penis from the base towards the tip.
It's just a drop, is this normal? Should I go to the hospital for an examination? Should I specifically check for prostate issues?
2.
Four months ago (from July to August), I had unprotected sexual intercourse.
Recently, I underwent an HIV test (in October, and I plan to do another one in January) and a routine urinalysis (in December), both of which returned normal results.
The doctor indicated that I should not have any issues, so I did not pursue further testing.
However, I found information online stating that male infections have a 50% asymptomatic rate for Chlamydia and 70% for Trichomonas.
Given that my routine urinalysis was normal, should I proactively request the doctor to conduct more detailed tests? Can I request a comprehensive STI screening at a reputable hospital (such as Chang Gung or Shin Kong Urology) even if it’s out-of-pocket, as I want to clarify everything at once to avoid unnecessary visits, considering the doctor's time is valuable?
3.
Previously, I suspected I had epididymitis (due to swelling and pulling sensations in the testicles, which sometimes still occur), so the doctor arranged for an ultrasound (in December).
The results showed that I have a varicocele, and the doctor advised that surgery is not necessary at this time.
However, I would like to know if it is possible for the ultrasound to only detect the varicocele and miss the epididymitis or other symptoms?
4.
In December, I noticed slight redness and swelling at the tip of the glans, but there was no pain or itching.
I suspected it might be an allergy, so I applied an ointment for 3-4 days, and it resolved.

These are my examination situations over the past three months.
Could you please provide me with further advice? Thank you for your patience, and I apologize for the lengthy message.

Niming, 30~39 year old female. Ask Date: 2020/01/13

Dr. Li Xinyi reply Urology

Discharge from the urethra can actually be considered normal.
However, due to previous risky sexual behavior, you may feel concerned.
In this regard, you are worried about possible infections such as trichomoniasis and chlamydia.
If you are truly concerned, it is advisable to get tested or you may consider taking medication as a precautionary treatment, which should be discussed with your physician.
Additionally, no test can guarantee 100% accuracy, so a scrotal ultrasound is not infallible.
However, epididymitis should present with obvious symptoms, and it may be possible to diagnose it through a physical examination without the need for an ultrasound.

Reply Date: 2020/01/13

More Info

When it comes to understanding morning urethral discharge, it's important to differentiate between normal physiological occurrences and potential signs of underlying health issues. Based on your description, the presence of a small amount of clear discharge upon squeezing the penis in the morning could be considered normal, particularly if it is minimal and not accompanied by other symptoms such as pain, itching, or a change in the color or consistency of the discharge. This type of discharge can sometimes be a result of natural secretions from the prostate or seminal vesicles, which can occur during sleep.

However, given your history of unprotected sexual intercourse four months ago, it is prudent to remain vigilant about sexually transmitted infections (STIs). While your recent HIV and routine urine tests returned normal results, it is important to remember that certain STIs, including Chlamydia and Trichomonas, can be asymptomatic in many cases. Therefore, if you have concerns about potential infections, it is advisable to discuss this with your healthcare provider. You can certainly request a more comprehensive STI screening, which can include tests for Chlamydia, Gonorrhea, and other infections, even if your initial tests were normal. Many urology clinics, including those at reputable hospitals like Chang Gung or Shin Kong, offer full STI panels, and you can inquire about self-pay options if necessary.

Regarding your concerns about epididymitis and the ultrasound findings of varicocele, it is possible for an ultrasound to focus on certain findings while potentially overlooking others, especially if the primary concern was the varicocele. If you are still experiencing discomfort in the testicular area, it would be wise to follow up with your urologist. They may consider further imaging or examinations to rule out epididymitis or other conditions that could be contributing to your symptoms.

As for the mild redness and swelling at the tip of the glans that resolved with topical treatment, this could have been a localized allergic reaction or irritation. If such symptoms recur, it may be worth discussing with your doctor, as persistent changes in the genital area can sometimes indicate an underlying condition that may require further evaluation.

In summary, while the morning discharge you described may not be alarming, your history and ongoing symptoms warrant a proactive approach. It is advisable to consult with your healthcare provider about your concerns, request a comprehensive STI screening, and discuss any persistent discomfort or changes in your genital area. Regular follow-ups and open communication with your healthcare provider are key to maintaining your sexual health and overall well-being.

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