Gleet is a term referring to a persistent, often mild, urethral discharge, primarily affecting men. While the word is less common in modern medical discussions, the symptom it describes—a chronic weeping or oozing from the urethra—remains a concern, indicating an underlying, low-grade inflammatory process. This symptom is distinct from the heavy, purulent discharge associated with acute infections.
Defining Gleet: Historical and Modern Context
Historically, “gleet” described the thin, watery, or mucoid discharge that persisted long after the acute, thick discharge of a gonorrheal infection had subsided. It was considered a late-stage or chronic manifestation of Neisseria gonorrhoeae infection that was inadequately treated in the pre-antibiotic era. This established gleet as a symptom of deep-seated, chronic inflammation within the urethral lining.
In contemporary medicine, “gleet” is understood as a descriptive symptom rather than a specific diagnosis. It typically presents as a small amount of clear or cloudy discharge, often only noticeable in the morning as it “glues” the urethral opening shut. This discharge is recognized as a sign of chronic, low-grade urethritis, resulting from various infectious or non-infectious causes, often following a poorly resolved acute episode.
Underlying Medical Causes
The primary contemporary cause of gleet is chronic or persistent non-gonococcal urethritis (NGU), which is inflammation of the urethra not caused by gonorrhea. The discharge persists because the initial pathogen was not fully eradicated or because inflammation triggered long-term changes in the urethral tissue. A significant portion of persistent NGU cases is attributed to pathogens difficult to eliminate, such as Mycoplasma genitalium, which accounts for up to 40% of refractory cases.
Other infectious agents include Ureaplasma urealyticum and Trichomonas vaginalis. These organisms cause a low-grade infection, leading to the scant discharge characteristic of gleet. They can colonize the urethral lining and sometimes the prostate gland, resulting in a continuous, low-level inflammatory response.
Beyond infectious causes, structural issues within the urinary tract can also result in chronic discharge. Urethral strictures, areas of scarring and narrowing, impede the normal flow of urine and secretions. This obstruction creates a pocket where inflammatory byproducts accumulate, leading to chronic irritation. Chronic prostatitis is another non-urethral source, as prostatic fluid can drain into the urethra and present as a discharge.
Diagnosis and Medical Evaluation
A medical evaluation begins with a detailed patient history, focusing on sexual activity, previous STIs, and prior antibiotic treatments. The clinician performs a physical examination, often involving gently “milking” the urethra to express scant discharge for collection. Obtaining a sample of the actual discharge is often more informative than a urine sample alone.
Laboratory testing centers on identifying the underlying cause and confirming persistent infectious agents. Nucleic Acid Amplification Tests (NAATs) are the gold standard for detecting Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, and Trichomonas vaginalis from urethral swabs or first-void urine. Microscopic evaluation of the urethral smear assesses inflammation by counting polymorphonuclear leukocytes (PMNs) to confirm urethritis. If infectious causes are ruled out, specialized testing, such as cystoscopy or urethrography, may be necessary to investigate structural causes like urethral strictures.
Treatment and Resolution
Treatment for gleet depends entirely on the successful identification of its specific cause. For chronic NGU caused by a persistent pathogen like Mycoplasma genitalium, treatment involves a targeted course of antibiotics, such as moxifloxacin or a combination regimen. Medication choice is tailored to combat potential antimicrobial resistance.
If the underlying cause is a urethral stricture, treatment shifts from antimicrobials to procedural intervention. This may involve urethral dilation to stretch the narrowed area, or a urethroplasty to surgically reconstruct the urethra. If no clear infectious or structural cause is found, anti-inflammatory medication may be trialed to reduce chronic irritation. Follow-up testing is necessary to confirm infection eradication and complete resolution of the discharge.