GENERAL-PRACTITIONERS IMMEDIATE MANAGEMENT OF MEN PRESENTING WITH URETHRAL SYMPTOMS

Objectives: To describe the immediate reported management, by general practitioners (GPs), of men presenting with symptoms of urethral disch arge, or dysuria only. Subjects: All 692 GPs in practice in Brent, Har row, Ealing, Hammersmith, and Hounslow (UK). Method: Data were collect ed using a GP completed questionnaire concerning the management of the last male patient seen, aged less than 40 years, complaining of ureth ral discharge, and the last male patient under 40 years complaining of dysuria only. Results: The response rate among GPs was 52%. Fifty thr ee per cent of men with urethral symptoms, 86% of men with a urethral discharge and 24% with dysuria only, were identified by GPs and referr ed without investigation or treatment to a genitourinary medicine clin ic. Of men with dysuria only, 93% of investigations by GPs were report ed to include a mid-stream urine (MSU) specimen for bacteriology, and 19% a urethral swab for chlamydia. Seventy eight per cent of GPs repor ted using treatments with a broad spectrum antibiotic, 53% with trimet hoprim, whilst 14% of GPs reported using a tetracycline in common use to treat non-gonococcal urethritis. Urine specimens were reported to b e ''culture positive'' in 41% of men who had an MSU specimen tested, a nd 15% of men who had a urethral swab tested were reported to be chlam ydia positive. Conclusion: The GPs included in this study were not a f ull sample, or representative of all the GPs, and the data are retrosp ective. Nevertheless, we found a large difference in GPs reported mana gement for men with urethral symptoms according to whether or not uret hral discharge was a reported complaint. Reported management is likely to be, at least, indicative of actual management. Therefore, the resu lts suggest that assessment by GPs of men presenting with dysuria shou ld be explored and more appropriate management strategies defined.