“Gleet” is an archaic term rarely heard in contemporary medical practice, yet it describes a symptom that persists today. Historically, the word denoted a specific kind of urethral discharge, typically chronic, watery, or thin. This persistent symptom often followed an acute infection that seemed to have cleared. Modern medicine now focuses on identifying the underlying infectious and non-infectious causes rather than the historical name.
The Historical Context and Description
The term “gleet,” sometimes called the “running gleet,” described a condition distinct from the initial, severe stages of venereal diseases. It was strongly associated with the later, drawn-out phases of chronic gonorrhea. The discharge was typically scanty, thin, and mucoid, differing from the thick, purulent discharge seen during an acute infection.
The symptom represented a persistent, low-level inflammation of the urethral lining that could last for weeks or months. It was often a clear or slightly cloudy, watery secretion that reappeared despite initial, often ineffective, treatments. This chronic inflammation often led to complications like urethral strictures, which are narrowings of the urethra.
Modern Causes of Persistent Urethral Discharge
The symptom historically known as gleet is now categorized as persistent urethral discharge, most often Non-Gonococcal Urethritis (NGU). NGU is an inflammation of the urethra not caused by the bacterium Neisseria gonorrhoeae. It accounts for a significant portion of urethritis cases, caused by a variety of pathogens.
The most frequently identified infectious agent in NGU is Chlamydia trachomatis, causing 15% to 40% of cases. Another recognized cause is Mycoplasma genitalium, a small bacterium found in 15% to 25% of NGU cases and a common cause of recurrent symptoms. Ureaplasma urealyticum and Trichomonas vaginalis are other pathogens that can also lead to this chronic, watery discharge.
Persistent urethral discharge can also be traced to non-infectious causes. These etiologies include mechanical irritation, such as from repeated urethral instrumentation or trauma. Chemical irritation from soaps, spermicides, or other personal hygiene products can also cause chronic inflammation. Chronic prostatitis, an inflammation of the prostate gland, can sometimes be the source of a persistent, thin urethral secretion.
Medical Evaluation and Management
A person experiencing a persistent, thin urethral discharge should seek a medical evaluation to determine the specific cause. The diagnostic process begins with a medical history and physical examination, followed by laboratory testing. The preferred diagnostic method is the use of Nucleic Acid Amplification Tests (NAATs), which are highly sensitive and accurately detect the genetic material of specific pathogens.
A first-catch urine sample is typically collected, as it contains cells and discharge from the urethra, making it the preferred specimen for NAAT testing in males. Laboratory analysis screens specifically for Neisseria gonorrhoeae and Chlamydia trachomatis, the most common causes of urethritis. If these tests are negative, further NAATs may check for other relevant pathogens, including Mycoplasma genitalium and Trichomonas vaginalis.
Management of the condition is based directly on the identified cause. For infections like Chlamydia, a single dose of azithromycin or a seven-day course of doxycycline is the standard treatment protocol. If Mycoplasma genitalium is diagnosed, treatment is often more complex, involving a multi-step regimen due to rising rates of antibiotic resistance, often using macrolides like azithromycin or moxifloxacin.
Patients must complete the entire course of antibiotics exactly as prescribed, even if symptoms resolve quickly, to ensure the infection is fully eradicated. The management strategy also requires the concurrent treatment and notification of sexual partners. Failure to treat partners is the most common reason for reinfection and the persistence of symptoms.