Treatment of Penile Shaft Swelling and Pus Discharge in Adults

Diagnostic Evaluation and Empiric Treatment

The European Association of Urology recommends initiating empiric antibiotic therapy immediately with ceftriaxone 1 g IM/IV plus doxycycline 100 mg orally twice daily for 10 days, while simultaneously performing urgent diagnostic evaluation to rule out abscess formation that may require surgical drainage 1
A Gram stain of urethral discharge should be performed to identify polymorphonuclear leukocytes and presumptively diagnose gonococcal infection, as recommended by the Centers for Disease Control and Prevention 2, 3
Nucleic acid amplification test (NAAT) on first-void urine or urethral swab for N. gonorrhoeae and C. trachomatis should be conducted, as suggested by the European Urology guidelines 1
Urethral swab culture before treatment initiation should be performed to assess antimicrobial resistance profiles, according to the European Urology guidelines 1

For patients under 35 years, the primary regimen should be ceftriaxone 1 g IM or IV single dose PLUS doxycycline 100 mg orally twice daily for 10 days, as recommended by the European Urology and Centers for Disease Control and Prevention guidelines 1, 2, 4
For patients 35 years or older, or when an enteric organism is suspected, the primary regimen should be ofloxacin 300 mg orally twice daily for 10 days OR levofloxacin 500 mg orally once daily for 10 days, as suggested by the Centers for Disease Control and Prevention and European Urology guidelines 2, 3, 4

Immediate surgical consultation and drainage are required if there is failure to improve within 3 days of antibiotic initiation, as recommended by the Centers for Disease Control and Prevention guidelines 2, 3, 4

Bed rest, scrotal elevation, and analgesics should be provided until fever and inflammation subside, as suggested by the Centers for Disease Control and Prevention guidelines 2, 3, 4
Patients should avoid sexual intercourse until therapy is completed and symptoms are resolved, as recommended by the Centers for Disease Control and Prevention guidelines 3, 4

Mandatory reassessment at 3 days is required, and if there is no improvement, the differential diagnosis should be broadened to include tumor, testicular infarction, fungal infection, or Streptococcus intermedius abscess, as suggested by the Centers for Disease Control and Prevention guidelines 2, 3

For confirmed or suspected sexually transmitted infections, all sexual partners who had contact within 60 days preceding symptom onset should be referred for evaluation and treatment, as recommended by the Centers for Disease Control and Prevention guidelines 3, 4

HIV-positive or immunocompromised patients should be treated with the same antibiotic regimens as immunocompetent patients, and a higher suspicion for atypical organisms should be maintained, as suggested by the Centers for Disease Control and Prevention guidelines 3, 4
Geographic considerations, such as local quinolone resistance patterns, should be taken into account before prescribing fluoroquinolones, particularly if the infection was acquired in Asia or Pacific regions, as recommended by the Praxis Medical Insights guidelines 4