Which symptom most likely prompted a male patient with gonorrhea to seek medical attention?

• A. Rashes on the palms and soles
• B. Cauliflower-like warts on the penis
• C. Painful red papules on the shaft of the penis
• D. Foul-smelling discharge from the penis

Answer: (D)

Gonorrhea in men most often presents with urethral inflammation that produces a noticeable discharge. The purulent, sometimes thick penile discharge (often accompanied by burning with urination) is the symptom that most commonly prompts a man to seek medical care. This makes the discharge the most characteristic and actionable sign of the infection.

Other signs point to different sexually transmitted infections: a rash on the palms and soles is typical of secondary syphilis; cauliflower-like warts on the penis indicate HPV; and painful red papules on the shaft suggest herpes or another ulcerative lesion. While gonorrhea can involve various symptoms, the visible penile discharge is the clue that patients most commonly bring them in for evaluation and testing. Diagnosis is usually via nucleic acid amplification testing of a urine sample or urethral swab, and treatment should follow guidelines due to the possibility of co-infection with other STIs.