Asymptomatic men: should they be tested for urethritis?
- Correspondence to: Dr Horner the Milne Centre, Bristol Royal Infirmary, Lower Maudlin Street, Bristol BS2 8HW, UK; paddy.horner{at}bristol.ac.uk
More research is needed to determine the cost effectiveness of testing for urethritis
Although more evidence has accumulated since questioning the role of testing for urethritis in asymptomatic men in 2002,1 there is as yet no definitive answer. Men with asymptomatic urethritis have 2–3 times the risk of having Chlamydia trachomatis and/or Mycoplasma genitalium detected compared with those with no urethritis (table 1). I am concerned that abandoning testing for urethritis could do more harm than good in high risk asymptomatic men.
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Estimated risk of having Chlamydia trachomatis and/or Mycoplasma genitalium in high risk young men with and without urethritis (Gram-stained urethral smear with or without first passed urine Gram-stained thread17), and their partners, depending on clinical findings
Testing for urethritis in men attending departments of genitourinary medicine has the following purposes.
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To allow immediate treatment of men with C trachomatis and/or M genitalium with an associated reduction in on-going transmission in the community.2,3 Currently there is no commercial test for M genitalium.
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To identify partners who may be at increased risk of these infections despite the index patient testing negative for C trachomatis and/or M genitalium.2,4–6
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For men at high risk of HIV, it is a potential marker for increased HIV susceptibility and infectivity.2
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High negative predictive value (NPV) (>97%) for C trachomatis and/or M genitalium in those without urethritis.5,7
ANALYSIS OF CURRENT LITERATURE ON URETHRITIS WITH A UNIFYING HYPOTHESIS ON THE AETIOLOGY
The literature on urethritis is full of contradictory findings, which make interpretation difficult. I believe that we need to be able to explain these conflicting observations, in order to understand the true value of testing for urethritis in clinical practice. For example (1) Angarius et al detected C trachomatis and/or M genitalium in only 26% of men with acute urethritis, whereas Falk et al, Totten et …
