This case of gonococcal Tysonitis, without preceding Comment or concomitant urethritis, is described mainly because Gonococcal Tysonitis is an uncommon complication the patient deliberately used post-coital urination as a of gonorrhoea. It is even less commonly encountered method of trying to prevent venereal disease. as an isolated finding without preceding or concomi-Case report tant gonococcal urethritis. A 44-year-old married man attended a venereal The hypothesis relating to post-coital

more »

... nation as a diseases clinic complaining of discomfort in the penis of prophylactic method for males is that bypassing urine 5 days' duration. He said that he seldom had intercourse within a few minutes after ejaculation any gonococci or with his wife because of her chronic ill-health; but he other pathogens which have entered the urethra admitted to frequent extramarital sexual relationships during coitus are flushed out before they have had over many years with casual acquaintances and prostitutes. time to become established on and in the urethral The last exposure to sexual infection had been intercourse mucous membrane. with a prostitute 9 days before attending. In considering prophylactic post-coital urination, PREVIOUS HISTORY He had attended the same clinic 3 there are at least three questions which require years previously suffering from acute gonorrhoea, which discussion: was treated and cured by an injection of penicillin. (1) Does post-coital urination have any prophylactic EXAMINATION AND TREATMENT There was a small tender value? A search of the literature has produced little swelling at the left side of the fraenum and pus was information. Arya and Bennett (1968) included expressed from the left Tyson's duct. A Gram-stained urination after sexual contact as one of the items of smear of the pus showed typical intracellular Gram-knowledge of prophylactic measures of venereal negative diplococci and gonococci were grown on culture. disease. Bennett (1968) wrote that some students in There were no signs of urethritis and both specimens of * t urine in the 2-glass test were clear and free from threads. Uganda thought that urnatilon helped to prevent He was treated with a single injection of 1-25 m.u. gonorrhoea but the details were not clear. Willcox penicillin (0 5 m.u. each of benzyl and procaine penicillin (1964) recommended that after intercourse a man plus 0-25 m.u. benethamine penicillin), and 4 days later should urinate, preferably in short sharp gushes, the the Tyson's abscess had subsided and again there were mechanical effect of which was to flush the urethra. no signs of urethritis or pyuria. Bernfeld (1961) , in a comprehensive survey of the He remained under observation for 3 months, and during literature on gonorrhoea of the median raphe of the this time tests of cure, including repeated examination of penis, reported that in 46 of the 63 certain cases, the the urine and prostatic secretion, all gave negative results. urethra was expressly said to be free from infection. FURTHER HISTORY In view of the unusual finding of Mills (1924) described a case of gonococcal infection gonococcal Tysonitis without preceding or concomitant of a sebaceous follicle of the prepuce in which there urethritis, the patient was asked for more information was no concomitant urethritis. Whether any of these about his sexual behaviour. He said that when he was in males practised post-coital urination was not stated. the army about 25 years previously, a lecturer on hygiene (2) Assuming that post-coital urination is a prophyhad advised the audience of soldiers always to pass urine (2) Assuming to best-coital what is the immediately after sexual intercourse. He had usually tried lactic procedure to be recommended, what is the to carry out this advice but occasionally found that he was maximum effective interval of time between ejacuunable to pass urine or was too befuddled by alcohol to lation and urination? From information given by remember to do so. On one such occasion 3 years prethree patients (including the one mentioned in this viously he had contracted gonorrhoea. paper), all of whom believed that they avoided Paper read to the MSSVD on May 15, 1970 attacks of urethritis by post-coital urination, the time