IN PRACTICE

Symptoms of non-gonococcal urethritis in heterosexual men: a case control study

P Iser¹, TR H Read², S Tabrizi³, C Bradshaw^1,2, D Lee^1,2, L Horvarth², S Garland³, I Denham² and C K Fairley^1,2

¹ School of Population Health, University of Melbourne, Parkville, 3052, Australia
² Melbourne Sexual Health Centre, 580 Swanston Street, Carlton, 3053, Australia
³ Royal Women’s Hospital, Grattan Street, Carlton, 3053, Australia

Correspondence to:
Correspondence to:
Christopher K Fairley
Melbourne Sexual Health Centre, 580 Swanston Street, Carlton, Victoria 3053, Australia; cfairley{at}unimelb.edu.au

Objective: To determine microbial and behavioural factors contributing to non-gonococcal urethral symptoms in men.

Methods: Case-control study of heterosexual men with non-gonococcal urethral symptoms (cases) and without urethral symptoms (controls) attending Melbourne Sexual Health Centre, Australia. Sexual behaviour and condom use were measured by questionnaire. First stream urine was tested for potential pathogens: Chlamydia trachomatis (ligase chain reaction), Mycoplasma genitalium (polymerase chain reaction, PCR), Ureaplasma urealyticum (culture and PCR), and Streptococcus spp, Gardnerella vaginalis, and Haemophilus species (culture). Urethral smears from cases were examined for polymorphonuclear leucocytes.

Results: 80 cases and 79 controls were recruited over 4 months in 2002–3. 49 cases (61%) had urethritis by microscopic criteria, 17 (21%) had Chlamydia trachomatis (adjusted odds ratio (OR) 27 (95% confidence interval (CI): 3.4 to 222)), five (6%) had Mycoplasma genitalium (OR 6.1 (95% CI: 0.6 to 61)), and 11 (14%) had Gardnerella vaginalis (OR 9.0 (95% CI: 1.6 to 52)). Other organisms were not significantly associated with urethral symptoms. The presence of urethritis on urethral smear did not predict the presence of Chlamydia trachomatis (OR 1.7 (95% CI: 0.5 to 5.4)). Urethral symptoms were significantly associated with unprotected vaginal sex with more than one casual partner (OR 9.3 (95% CI: 1.3 to 65)) and unprotected anal sex with a regular partner in the past month (OR 3.5 (95% CI: 1.0 to 13)).

Conclusion: Gardnerella vaginalis and unprotected anal sex may cause symptoms of non-gonococcal urethritis. Microscopy of the urethral smear to diagnose urethritis in this population does not help to identify which men with urethral symptoms require treatment for chlamydia.

Abbreviations: NGU, non-gonococcal urethritis; PCR, polymerase chain reaction

Keywords: non-gonococcal urethritis; non-specific urethritis; Gardnerella vaginalis; urethritis

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Shahmanesh, M, Moi, H, Lassau, F, Janier, M (2009). 2009 European Guideline on the Management of Male Non-gonococcal Urethritis. Int J STD AIDS 20: 458-464 [Full Text]  
• Moi, H, Reinton, N, Moghaddam, A (2009). Mycoplasma genitalium is associated with symptomatic and asymptomatic non-gonococcal urethritis in men. Sex. Transm. Infect. 85: 15-18 [Abstract] [Full Text]  
• Teague, R, Fairley, C K, Newton, D, Bradshaw, C, Donovan, B, Bowden, F, Cummings, R, Chen, M Y (2008). How men with non-chlamydial, non-gonococcal urethritis are managed in Australasia. Int J STD AIDS 19: 581-585 [Abstract] [Full Text]  
• Fung, M., Scott, K. C, Kent, C. K, Klausner, J. D (2007). Chlamydial and gonococcal reinfection among men: a systematic review of data to evaluate the need for retesting. Sex. Transm. Infect. 83: 304-309 [Abstract] [Full Text]  
• Shahmanesh, M, Radcliffe, K W (2007). Is the urethral smear necessary in asymptomatic men attending a genitourinary medicine clinic?. Sex. Transm. Infect. 83: 79-81 [Full Text]