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Bellinato F, Maurelli M, Gisondi P, Lleo Fernandez M, Girolomoni G. Clinical profile and co-infections of urethritis in males. Ital J Dermatol Venerol 2021; 156:681-685. [PMID: 33423450 DOI: 10.23736/s2784-8671.20.06773-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Infectious urethritis are classified in N. gonorrhoeae (NG) urethritis and non-gonococcal urethritis, caused commonly by C. trachomatis (CT) or M. genitalium (MG) in Western Europe. The primary objective of the study is to evaluate the association between the clinical profile and the pathogens. Secondly, to assess the prevalence of co-infections. METHODS The clinical profile of urethritis in men caused by NG, CT and MG confirmed by nucleic acid amplification test (NAAT) on first void urine has been retrospectively collected. The clinical profiles comprised the assessment of dysuria and/or discharge and the clinical-dermoscopic examination of the genitalia. Serological tests for syphilis and HIV were also performed. RESULTS A total of 101 episodes of NAAT confirmed NG, CT or MG urethritis were identified. The prevalence for each pathogen was 50.60%, 33.73% and 15.66%, respectively. Co-infections were observed in few cases (four MG+CT, one NG+CT, one NG+MG), with M. hominis, U. urealitycum and U. parvum positivity found concomitantly in 7-8% cases. The median age of patients was 33 years. Dysuria was reported in 88% cases (95% NG, 79% CT, 78% MG urethritis). Urethral discharge was found in 86% of cases, including purulent discharge in 61% (98% NG, 70% MG) and transparent in 25% (64% CT). Dysuria and purulent discharge were observed in 95% NG, 54% MG and 29% CT cases, whereas dysuria and transparent discharge were observed in 50% CT, 23% MG and in none of NG cases (P<0.01). Balanitis/meatitis was observed in 24% of cases, genital warts in 12% and proctalgia in 4%. CONCLUSIONS NAAT is crucial for defining urethritis etiology. Dysuria is the most common symptom. Gonococcal urethritis present with purulent discharge, whereas transparent discharge is associated with non-gonococcal pathogens. Co-infections are rare. Clinical exam may detect other infectious diseases, in particular genital warts.
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Affiliation(s)
- Francesco Bellinato
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy -
| | - Martina Maurelli
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Paolo Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Maria Lleo Fernandez
- Section of Microbiology, Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - Giampiero Girolomoni
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
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Tjagur S, Mändar R, Punab M. Profile of sexually transmitted infections causing urethritis and a related inflammatory reaction in urine among heterosexual males: A flow-cytometry study. PLoS One 2020; 15:e0242227. [PMID: 33264307 PMCID: PMC7710099 DOI: 10.1371/journal.pone.0242227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 10/28/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Information about the use of flow cytometry in the diagnosis of male urethritis is scarce. The current study aims to evaluate the performance of flow cytometry on first-voided urine in males with infectious urethritis (Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium and Trichomonas vaginalis). METHODS Male patients of the Andrology Centre (Tartu University Hospital, Estonia) were recruited during the period March 2015 -January 2018. Cases included 306 patients with infectious urethritis caused by Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium and/or Trichomonas vaginalis. The control group consisted of 192 patients without uro-genital complaints, negative tests for C. trachomatis, N. gonorrhoeae, M. genitalium and T. vaginalis from first-voided urine and no inflammation in first-voided urine, mid-stream urine and urine after prostate massage. C. trachomatis, N. gonorrhoeae, M. genitalium and T. vaginalis were detected from first-voided urine using polymerase chain reaction (PCR) method. First-voided urine was analysed using urine particle analyzer Sysmex UF-500i. RESULTS The most prevalent infection was chlamydia (64.1%), followed by Mycoplasma genitalium (20.9%), gonorrhoea (7.8%) and trichomoniasis (1.6%). Gonorrhoea caused the highest flow-cytometric leucocyte/bacteria count, followed by chlamydia and Mycoplasma genitalium. Trichomonas vaginalis showed nearly absent inflammation in first-voided urine. Using an empiric flow-cytometry diagnostic threshold for urethritis in first-voided urine (leucocytes ≥ 15/μl and bacteria ≥ 20/μl) the total calculated sensitivity was over 90%. However, when applying such criteria for deciding whether to perform first-voided urine PCR for C. trachomatis, N. gonorrhoeae, M. genitalium and T. vaginalis or not, we could miss 23 cases with infectious urethritis that makes up 7,5% of all proven cases. CONCLUSIONS Flow cytometry of first-voided urine can be considered as a rapid and objective screening method in case of suspected male infectious urethritis.
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Affiliation(s)
- Stanislav Tjagur
- Andrology Centre, Tartu University Hospital, Tartu, Estonia
- Faculty of Medicine, University of Tartu, Tartu, Estonia
- * E-mail:
| | - Reet Mändar
- Department of Microbiology, Institute of Biomedicine and Translational Medicine, Faculty of Medicine, University of Tartu, Tartu, Estonia
- Competence Centre on Health Technologies, Tartu, Estonia
| | - Margus Punab
- Andrology Centre, Tartu University Hospital, Tartu, Estonia
- Institute of Clinical Medicine, Faculty of Medicine, University of Tartu, Tartu, Estonia
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Abstract
Mycoplasmagenitalium is one of the major causes of nongonococcal urethritis (NGU) worldwide but an uncommon sexually transmitted infection (STI) in the general population. The risk of sexual transmission is probably lower than for Chlamydia trachomatis. Infection in men is usually asymptomatic and it is likely that most men resolve infection without developing disease. The incubation period for NGU caused by Mycoplasma genitalium is probably longer than for NGU caused by C. trachomatis. The clinical characteristics of symptomatic NGU have not been shown to identify the pathogen specific etiology. Effective treatment of men and their sexual partner(s) is complicated as macrolide antimicrobial resistance is now common in many countries, conceivably due to the widespread use of azithromycin 1 g to treat STIs and the limited availability of diagnostic tests for M. genitalium. Improved outcomes in men with NGU and better antimicrobial stewardship are likely to arise from the introduction of diagnostic M. genitalium nucleic acid amplification testing including antimicrobial resistance testing in men with symptoms of NGU as well as in their current sexual partner(s). The cost effectiveness of these approaches needs further evaluation. The evidence that M. genitalium causes epididymo-orchitis, proctitis, and reactive arthritis and facilitates human immunodeficiency virus transmission in men is weak, although biologically plausible. In the absence of randomized controlled trials demonstrating cost effectiveness, screening of asymptomatic men cannot be recommended.
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Affiliation(s)
- Patrick J Horner
- School of Social and Community Medicine, University of Bristol.,Bristol Sexual Health Centre, University Hospitals Bristol NHS Trust.,National Institute for Health Research Health, Protection Research Unit in Evaluation of Interventions in partnership with Public Health England, University of Bristol, United Kingdom
| | - David H Martin
- Department of Epidemiology, Tulane University School of Public Health.,Department of Medicine, Louisiana State University Health Sciences Center, New Orleans
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Horner PJ, Blee K, Falk L, van der Meijden W, Moi H. 2016 European guideline on the management of non-gonococcal urethritis. Int J STD AIDS 2016; 27:928-37. [DOI: 10.1177/0956462416648585] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 03/30/2016] [Indexed: 11/16/2022]
Abstract
We present the updated International Union against Sexually Transmitted Infections (IUSTI) guideline for the management of non-gonococcal urethritis in men. This guideline recommends confirmation of urethritis in symptomatic men before starting treatment. It does not recommend testing asymptomatic men for the presence of urethritis. All men with urethritis should be tested for Chlamydia trachomatis and Neisseria gonorrhoeae and ideally Mycoplasma genitalium using a nucleic acid amplification test (NAAT) as this is highly likely to improve clinical outcomes. If a NAAT is positive for gonorrhoea, a culture should be performed before treatment. In view of the increasing evidence that azithromycin 1 g may result in the development of antimicrobial resistance in M. genitalium, azithromycin 1 g is no longer recommended as first line therapy, which should be doxycycline 100 mg bd for seven days. If azithromycin is to be prescribed an extended course of 500 mg stat, then 250 mg daily for four days is to be preferred over 1 g stat. In men with persistent NGU, M. genitalium NAAT testing is recommended if not previously undertaken, as is Trichomonas vaginalis NAAT testing in populations where T. vaginalis is detectable in >2% of symptomatic women.
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Affiliation(s)
- Patrick J Horner
- School of Social and Community Medicine, University of Bristol, UK
- Bristol Sexual Health Centre, University Hospitals Bristol NHS Foundation Trust, UK
| | - Karla Blee
- Bristol Sexual Health Centre, University Hospitals Bristol NHS Foundation Trust, UK
| | - Lars Falk
- Department of Dermatology and Venereology, Linköping University Hospital, Sweden
- Department of Clinical and Experimental Medicine, Linköping University, Sweden
| | | | - Harald Moi
- Olafia Clinic, Oslo University Hospital, Institute of Medicine, University of Oslo, Norway
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Cox C, McKenna JP, Watt AP, Coyle PV. Ureaplasma parvum and Mycoplasma genitalium are found to be significantly associated with microscopy-confirmed urethritis in a routine genitourinary medicine setting. Int J STD AIDS 2015; 27:861-7. [PMID: 26378187 DOI: 10.1177/0956462415597620] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 06/29/2015] [Indexed: 11/17/2022]
Abstract
Inflammation of the urethra defined by an excess of polymorphonuclear leukocytes in the absence of sexually transmitted Chlamydia trachomatis and Neisseria gonorrhoeae is called non-chlamydial non-gonococcal urethritis (NCNGU). Although Mycoplasma genitalium is now recognised as causing a sexually transmitted infection, the clinical significance of the other Mollicute species is less clear. This study used specific real-time quantitative polymerase chain reaction assays to detect and quantify four Mollicute species, M. genitalium, M. hominis, Ureaplasma urealyticum and U. parvum, in urine specimens from men with and without NCNGU. A total of 165 urine specimens from male patients attending a genitourinary medicine clinic were eligible for the study, with microscopy-confirmed (≥5 polymorphonuclear leukocytes in urethral swab) NCNGU in 75 (45.5%) and non-confirmed NCNGU in 90 (54.5%). Chi-squared statistical analysis indicated a significantly higher prevalence of U. parvum (17.3% vs. 5.6%; p = 0.03) and M. genitalium (12% vs. 0%; p < 0.001) in NCNGU. In a subset analysis, M. genitalium was also significantly (p = 0.03) higher in men who have sex with men (MSM; 13.5%) compared to non-MSM (3.1%). No significant associations were reported for U. urealyticum and M. hominis In conclusion, this study supports a clinically significant role in NGNCU for both U. parvum and M. genitalium.
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Affiliation(s)
- Ciara Cox
- Regional Virus Laboratory, Belfast Health and Social Care Trust, Belfast, UK
| | - James P McKenna
- Regional Virus Laboratory, Belfast Health and Social Care Trust, Belfast, UK
| | - Alison P Watt
- Regional Virus Laboratory, Belfast Health and Social Care Trust, Belfast, UK
| | - Peter V Coyle
- Regional Virus Laboratory, Belfast Health and Social Care Trust, Belfast, UK
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6
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Horner P, Blee K, O'Mahony C, Muir P, Evans C, Radcliffe K. 2015 UK National Guideline on the management of non-gonococcal urethritis. Int J STD AIDS 2015; 27:85-96. [PMID: 26002319 DOI: 10.1177/0956462415586675] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 04/14/2015] [Indexed: 11/16/2022]
Abstract
We present the updated British Association for Sexual Health and HIV guideline for the management of non-gonococcal urethritis in men. This document includes a review of the current literature on its aetiology, diagnosis and management. In particular it highlights the emerging evidence that azithromycin 1 g may result in the development of antimicrobial resistance in Mycoplasma genitalium and that neither azithromycin 1 g nor doxycycline 100 mg twice daily for seven days achieves a cure rate of >90% for this micro-organism. Evidence-based diagnostic and management strategies for men presenting with symptoms suggestive of urethritis, those confirmed to have non-gonococcal urethritis and those with persistent symptoms following first-line treatment are detailed.
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Affiliation(s)
- P Horner
- School of social and Community Medicine, University of Bristol, Bristol, UK Bristol Sexual Health Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - K Blee
- Bristol Sexual Health Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - C O'Mahony
- Chester Sexual Health, Countess of Chester NHS Foundation Trust, Cheshire, UK
| | - P Muir
- Public Health Laboratory, Public Health England, Bristol, UK
| | - C Evans
- West London Centre for Sexual Health, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - K Radcliffe
- Whittall Street Clinic, Birmingham Sexual Health, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Park H, Sim SM, Lee G. The presence of Chlamydia is associated with increased leukocyte counts and pain severity in men with chronic pelvic pain syndrome. Urology 2015; 85:574-9. [PMID: 25733268 DOI: 10.1016/j.urology.2014.11.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 10/30/2014] [Accepted: 11/11/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the role of urinary chlamydial infection in patients with chronic prostatitis and/or chronic pelvic pain syndrome (CP-CPPS). METHODS We recruited men aged 18-55 years over 4 years. We excluded patients with acute urethritis and any acute genitourinary infections. The participants evaluated their CP-CPPS-like symptoms with the Korean version National Institutes of Health-Chronic Prostatitis Symptom Index questionnaires. We measured white blood cell (WBC) counts in expressed prostatic secretion (EPS). In-house nucleic acid amplification test for Chlamydia trachomatis and Neisseria gonorrhoeae detection and WBC counts were performed from the patient's first-voided urine. RESULTS A total of 765 eligible men were classified into 3 groups: 196 in non-CP-CPPS, 410 in noninflammatory CP-CPPS, and 159 in inflammatory CP-CPPS groups. The chlamydia-infected men showed higher pain, poor quality of life (QOL), and total scores in National Institutes of Health-Chronic Prostatitis Symptom Index questionnaires than the negative men (P = .041 for pain; P = .043 for QOL, and P = .027 for total). Multivariate analysis found that urinary chlamydial infection increased the risk of WBC count ≥16 in EPS (adjusted odds ratio [OR], 2.189; 95% confidence interval [CI], 1.021-4.690; P = .044) and WBC count between 2 and 4 in urine (OR, 5.227; 95% CI, 2.503-10.918; P = .001). In addition, chlamydial infection also increased the risk of inflammatory CP-CPPS than the non-CP-CPPS group (OR, 2.448; 95% CI, 1.010-5.932; P = .044), whereas the patients with noninflammatory CP-CPPS were not affected (OR, 1.6557; 95% CI, 0.738-3.717; P = .221). CONCLUSION Urinary chlamydial infection increased the pain scores and WBC counts in EPS and worsens the QOL in the patients with CP-CPPS.
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Affiliation(s)
- Heeyoon Park
- Department of Urology, Dankook University College of Medicine, Cheonan, Korea
| | - Seon-mi Sim
- Department of Molecular Diagnostics, SolGent, Daejeon, Korea
| | - Gilho Lee
- Department of Urology, Dankook University College of Medicine, Cheonan, Korea.
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8
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Pond MJ, Nori AV, Patel S, Laing K, Ajayi M, Copas AJ, Butcher PD, Hay P, Sadiq ST. Performance evaluation of automated urine microscopy as a rapid, non-invasive approach for the diagnosis of non-gonococcal urethritis. Sex Transm Infect 2015; 91:165-70. [PMID: 25614466 PMCID: PMC4413809 DOI: 10.1136/sextrans-2014-051761] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 10/22/2014] [Indexed: 11/28/2022] Open
Abstract
Objectives Gram-stained urethral smear (GSUS), the standard point-of-care test for non-gonococcal urethritis (NGU) is operator dependent and poorly specific. The performance of rapid automated urine flow cytometry (AUFC) of first void urine (FVU) white cell counts (UWCC) for predicting Mycoplasma genitalium and Chlamydia trachomatis urethral infections was assessed and its application to asymptomatic infection was evaluated. Methods Receiver operating characteristic curve analysis, determining FVU-UWCC threshold for predicting M. genitalium or C. trachomatis infection was performed on 208 ‘training’ samples from symptomatic patients and subsequently validated using 228 additional FVUs obtained from prospective unselected patients. Results An optimal diagnostic threshold of >29 UWC/µL gave sensitivities and specificities for either infection of 81.5% (95% CI 65.1% to 91.6%) and 85.8% (79.5% to 90.4%), respectively, compared with 86.8% (71.1% to 95%) and 64.7% (56.9% to 71.7%), respectively, for GSUS, using the training set samples. FVU-UWCC demonstrated sensitivities and specificities of 69.2% (95% CI 48.1% to 84.9%) and 92% (87.2% to 95.2%), respectively, when using validation samples. In asymptomatic patients where GSUS was not used, AUFC would have enabled more infections to be detected compared with clinical considerations only (71.4% vs 28.6%; p=0.03). The correlation between UWCC and bacterial load was stronger for M. genitalium compared with C. trachomatis (τ=0.426, p≤0.001 vs τ=0.295, p=0.022, respectively). Conclusions AUFC offers improved specificity over microscopy for predicting C. trachomatis or M. genitalium infection. Universal AUFC may enable non-invasive diagnosis of asymptomatic NGU at the PoC. The degree of urethral inflammation exhibits a stronger association with pathogen load for M. genitalium compared with C. trachomatis.
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Affiliation(s)
- Marcus J Pond
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - Achyuta V Nori
- Institute for Infection and Immunity, St George's University of London, London, UK Department of Genitourinary & HIV Medicine, St George's Healthcare NHS Trust, London, UK
| | - Sheel Patel
- Department of Genitourinary & HIV Medicine, St George's Healthcare NHS Trust, London, UK
| | - Ken Laing
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - Margarita Ajayi
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - Andrew J Copas
- Research Department of Infection and Population Health, University College London, Mortimer Market Centre, London, UK
| | - Philip D Butcher
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - Phillip Hay
- Institute for Infection and Immunity, St George's University of London, London, UK Department of Genitourinary & HIV Medicine, St George's Healthcare NHS Trust, London, UK
| | - Syed Tariq Sadiq
- Institute for Infection and Immunity, St George's University of London, London, UK Department of Genitourinary & HIV Medicine, St George's Healthcare NHS Trust, London, UK
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Recalibrating the Gram Stain Diagnosis of Male Urethritis in the Era of Nucleic Acid Amplification Testing. Sex Transm Dis 2012; 39:18-20. [DOI: 10.1097/olq.0b013e3182354da3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Lascar RM, Foo AS, Jungmann E. Microscopy for symptomatic men: not all symptoms are born equal. Int J STD AIDS 2011; 22:680-1. [DOI: 10.1258/ijsa.2009.009495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Summary We reviewed microscopy results for symptomatic male patients in order to identify clinical correlates of urethritis as diagnosed by same-day microscopy. Higher polymorph counts were found in patients presenting with discharge, or discharge together with dysuria, but dysuria without discharge was strongly associated with negative urethral microscopy. Symptoms were strongly linked to microscopy outcome but partnerships were not linked to either symptoms or outcome.
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Affiliation(s)
- R M Lascar
- Archway Sexual Health Clinic, Camden Provider Services, London, UK
| | - A S Foo
- Archway Sexual Health Clinic, Camden Provider Services, London, UK
| | - E Jungmann
- Archway Sexual Health Clinic, Camden Provider Services, London, UK
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Couldwell DL, Gidding HF, Freedman EV, McKechnie ML, Biggs K, Sintchenko V, Gilbert GL. Ureaplasma urealyticum is significantly associated with non-gonococcal urethritis in heterosexual Sydney men. Int J STD AIDS 2010; 21:337-41. [PMID: 20498103 DOI: 10.1258/ijsa.2009.009499] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We investigated the prevalence of various genital organisms in 268 men with (cases) and 237 men without (controls) urethral symptoms/signs (urethral discharge, dysuria and/or urethral irritation) from two sexual health clinics in Sydney between April 2006 and November 2007. The presence of urethral symptoms/signs was defined as non-gonococcal urethritis (NGU) for this study. Specific aims were to investigate the role of Ureaplasma urealyticum in NGU and the prevalence of Mycoplasma genitalium in our population. Multiplex polymerase chain reaction-based reverse line blot (mPCR/RLB) assay was performed to detect 14 recognized or putative genital pathogens, including Chlamydia trachomatis, M. genitalium, U. urealyticum and U. parvum. U. urealyticum was associated with NGU in men without another urethral pathogen (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.1-3.8; P = 0.04); this association remained after controlling for potential confounding by age and history of unprotected vaginal sex in the last four weeks (OR 2.0, 95% CI: 1.1-3.9; P = 0.03). C. trachomatis (OR 7.5, P < 0.001) and M. genitalium (OR 5.5, P = 0.027) were significantly associated with NGU. The prevalence of M. genitalium was low (4.5% cases, 0.8% controls). U. urealyticum is independently associated with NGU in men without other recognized urethral pathogens. Further research should investigate the role of U. urealyticum subtypes among heterosexual men with NGU.
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Affiliation(s)
- D L Couldwell
- Parramatta Sexual Health Clinic, Jeffery House, Parramatta, NSW 2150.
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12
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Shahmanesh M, Moi H, Lassau F, Janier M. 2009 European guideline on the management of male non-gonococcal urethritis. Int J STD AIDS 2009; 20:458-64. [PMID: 19541886 DOI: 10.1258/ijsa.2009.009143] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- M Shahmanesh
- Department of Genitourinary Medicine, Whittall Street Clinic, Birmingham, UK
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13
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Iwuji CC, Reeves I, Nambiar K, Richardson D. Diagnostic utility of urethral smears in predicting urethral chlamydia in HIV-infected men. Int J STD AIDS 2008; 19:741-3. [DOI: 10.1258/ijsa.2008.008118] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We collected data from 218 HIV-infected men to assess the usefulness of the urethral smear and symptoms in predicting Chlamydia trachomatis infection. Prevalence of urethral chlamydia was 9%. A polymorphonuclear leucocyte (PMNL) count ≥5 was 73% sensitive and 71% specific for C. trachomatis infection. Adjusted odds ratio for risk of chlamydial infection was significant for urethral irritation (7.48; 1.54–36.4), a PMNL count of 20 or more (9.83; 2.52–8.4) and a PMNL count of 5–19 (4.10; 1.34–12.5). We had to perform 50 urethral smears in HIV-positive men without symptoms to treat one case of C. trachomatis at the time of visit. Findings suggest that the presence of symptoms, in particular urethral irritation may be associated with chlamydial urethritis and that the higher the urethral PMNL count, the more likely it is for C. trachomatis to be detected. The findings in this study also lend further support to recent guidelines that urethral microscopy is not useful in asymptomatic men and hence should be abandoned.
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Affiliation(s)
- C C Iwuji
- Department of HIV and Genitourinary Medicine, Lawson Unit, Brighton and Sussex University Hospitals, Royal Sussex County Hospital, Brighton BN2 5BE
| | - I Reeves
- Ambrose King Centre, Royal London Hospital, Whitechapel, London E1 1BB, UK
| | - K Nambiar
- Department of HIV and Genitourinary Medicine, Lawson Unit, Brighton and Sussex University Hospitals, Royal Sussex County Hospital, Brighton BN2 5BE
| | - D Richardson
- Department of HIV and Genitourinary Medicine, Lawson Unit, Brighton and Sussex University Hospitals, Royal Sussex County Hospital, Brighton BN2 5BE
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Blume A, Main C, Patel R, Foley E. Should men with asymptomatic non-specific urethritis be identified and treated? Int J STD AIDS 2008; 19:744-6. [DOI: 10.1258/ijsa.2008.008121] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
There is currently a debate as to whether microscopy is necessary in asymptomatic men presenting for a sexual health screen. Arguments favouring microscopy include finding chlamydia in a significant proportion of sexual partners of men with non-specific urethritis (NSU) in studies that included symptomatic men. We aimed to investigate the proportion of partners of men with asymptomatic NSU who were diagnosed with a sexually transmitted infection. A retrospective case-note review was carried out for all men diagnosed with asymptomatic pathogen-negative NSU, and their traced sexual contacts, during a nine-month period. As a result of contact-tracing, we identified 42 partners who attended the clinic. Only one partner (2.4%) tested positive for chlamydia. A further two partners were diagnosed with a viral sexually transmitted infection (STI). The low level of chlamydia and other STIs in partners of asymptomatic men with pathogen-negative NSU does not support the routine use of microscopy to identify these patients.
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Affiliation(s)
- A Blume
- Department of GU Medicine, Royal South Hants Hospital
| | - C Main
- University of Southampton, Southampton, UK
| | - R Patel
- Department of GU Medicine, Royal South Hants Hospital
| | - E Foley
- Department of GU Medicine, Royal South Hants Hospital
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Shahmanesh M, Radcliffe KW. Is the urethral smear necessary in asymptomatic men attending a genitourinary medicine clinic? Sex Transm Infect 2007; 83:79-81. [PMID: 17435048 PMCID: PMC2598621 DOI: 10.1136/sti.2006.024653] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Available evidence does not support the performance of urethral smears in asymptomatic men
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Wikström A, Jensen JS. Mycoplasma genitalium: a common cause of persistent urethritis among men treated with doxycycline. Sex Transm Infect 2006; 82:276-9. [PMID: 16877573 PMCID: PMC2564707 DOI: 10.1136/sti.2005.018598] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2006] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/OBJECTIVE Persistent or recurrent non-gonococcal urethritis (NGU) is commonly observed in men attending sexually transmitted diseases clinics. The aim of this study was to determine the importance of Mycoplasma genitalium in this condition and to monitor the effect of treatment with macrolides. METHODS 78 male patients with persistent or recurrent symptomatic non-chlamydial NGU after treatment with doxycycline 200 mg day 1 and 100 mg for the following 8 days were enrolled. The patients had a first void urine specimen examined for the presence of M genitalium DNA by an inhibitor controlled PCR. Treatment with azithromycin and/or erythromycin and/or repeat doxycycline was prescribed at the doctor's discretion to the M genitalium positive men. Microbiological cure rate was determined at a 3 week follow up visit. RESULTS M genitalium was detected in 32 (41%) men and those infected had more often a high grade urethritis (>10 PMNLs/hpf) than those negative for M genitalium (p = 0.01). 22 men had been treated with azithromycin, 19 of whom received 1.5 g over 5 days and three received 1 g as a single dose. All 20 who came back after treatment were M genitalium negative. Only two of five erythromycin treated controlled cases were M genitalium negative after treatment compared to all six given azithromycin at inclusion (p = 0.12). Six of nine female partners were M genitalium positive; they were treated with 1.5 g azithromycin given over 5 days, and the four tested were M genitalium negative after treatment. CONCLUSIONS M genitalium is a common cause of persistent or recurrent urethritis among men treated with doxycycline and erythromycin appears to be less efficient than azithromycin in eradicating the infection.
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Affiliation(s)
- A Wikström
- Karolinska University Hospital, Solna, Karolinska Institutet, Department of Dermatovenereology, SE-171 76 Stockholm, Sweden.
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Bradshaw CS, Read RT, Fairley CK. Comment on editorial by B. Donovan: asymptomatic non-chlamydial non-gonococcal urethritis--an iatrogenic disease (Sexual Health 1, 65-67). The role of the urethral gram stain in non-gonococcal urethritis. Sex Health 2005; 1:187; discussion 188. [PMID: 16335307 DOI: 10.1071/sh04035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- C S Bradshaw
- School of Population Health, University of Melbourne, Parkville, Australia.
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Chen M, Donovan B. Reply to Comment by C. S. Bradshaw et al.: The role of the urethral Gram stain in non-gonococcal urethritis. Sex Health 2004. [DOI: 10.1071/sh04036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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