Urethral Discharge in Children
Urethral Discharge in Children | Paediatric Summary (UK)
Urethral Discharge in Children
Overview
Urethral discharge refers to fluid or exudate from the urethral meatus that is not urine. In children, it most commonly indicates a urinary tract infection (UTI) rather than a sexually transmitted infection (STI). A thorough assessment is essential to exclude irritant, traumatic, or infectious causes.
Common Causes
| Category | Example / Notes |
|---|---|
| Infectious (most common) | UTI — E. coli, Klebsiella, Proteus spp. Discharge in ~5% of <2-year-olds with UTI. |
| STI (rare in children) | N. gonorrhoeae, C. trachomatis — only in sexually active adolescents or if safeguarding concerns arise. |
| Irritant / Chemical | Bubble baths, soaps, creams, baby wipes. |
| Trauma / Foreign body | Instrumentation, catheterisation, meatal injury. |
| Dermatological / Other | Balanitis, smegma, peri-urethral irritation, vulvovaginitis. |
Key History Points
- Duration and nature of discharge (colour, odour, purulent?).
- Dysuria, frequency, urgency, fever, vomiting, flank pain.
- Recent trauma, catheterisation, new soaps or creams.
- Sexual history (if adolescent – ensure confidentiality and safeguarding awareness).
- Past UTIs, voiding pattern, constipation.
- Systemic features: lethargy, poor feeding, fever (especially <3 months).
Examination Checklist
- Inspect urethral meatus for erythema, irritation, discharge.
- Palpate for suprapubic or loin tenderness.
- Assess hydration, temperature, general appearance.
- Examine genital area: balanitis, phimosis, vulvovaginitis.
- Look for systemic features (toxicity, sepsis).
Investigations (NICE NG224 aligned)
| Test | Indication |
|---|---|
| Urine dipstick & culture | All children with suspected UTI or urethral discharge. |
| MSU / Clean-catch sample | Preferred method; catheter sample if needed. |
| NAAT (STI testing) | For sexually active adolescents or safeguarding cases. |
| Ultrasound | For atypical or recurrent UTI (not first episode). |
| Blood tests | If systemically unwell (FBC, CRP, U&E, cultures). |
Management Summary
Infants <3 months
- Admit urgently for inpatient management.
- Start IV antibiotics per local UTI/sepsis protocol.
- Discuss with senior paediatrician early.
Children ≥3 months (systemically well)
- Send urine for culture before antibiotics if possible.
- Empirical oral antibiotics per local policy:
Trimethoprim, Nitrofurantoin, or Cefalexin (age/weight appropriate). - Encourage fluids and regular voiding.
- Treat constipation and avoid irritant hygiene products.
- Review within 48 hours and adjust per culture result.
Adolescents / STI suspected
- Refer to paediatric sexual health / GUM clinic.
- Take NAATs for N. gonorrhoeae & C. trachomatis.
- Treat per <a hr
- Sources: NICE NG224 (UTI in under-16s, 2022), RCEMLearning, UK Paediatric Nephrology & Sexual Health guidance, and Frontiers in Pediatrics (2023).
