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UG4 Non-Specific Urethritis: Can we be a little more specific?
  1. Genevieve Hirst1,
  2. Daniel Richardson2,
  3. Suneeta Soni2
  1. 1Peninsula Medical School, Truro, UK
  2. 2Brighton and Sussex University Hospitals NHS Trust, Brighton, UK

Abstract

Background/introduction The causes of non-specific urethritis (NSU) in men are many and in GUM clinics, evidence for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) is routinely sought. Mycoplasma genitalium (MG) accounts for 5–33% of urethritis but is not routinely tested for in the UK. There is growing concern that widespread use of 1g Azithromycin is leading to macrolide resistance in many organisms including MG.

Aim(s)/objectives To describe the current management of men with confirmed urethritis and their outcomes.

Methods Men with diagnoses of NSU from January to July 2015 were identified. Data were collected from electronic patient records. p values were obtained using chi-square test.

Results 254 cases of NSU were identified, median age 30 (range 16–69 years). 181/254 (71%) heterosexual, 73/254 (29%) MSM, 21/254 (8%) HIV-positive. Rates of urethral CT and GC were 15% (n = 40) and 1% (n = 2) respectively. 21/254 (8%) had persistent dysuria or discharge; 15/21 of those were tested for MG; MG detected in 5/15 (33%). Pathogens were identified in 17% of cases and heterosexual men were more likely to have pathogen-positive urethritis than MSM (p = 0.02). First line treatment: 93% 1 g Azithromycin, 2.8% doxycycline 100 mg bd 7/7.

Discussion/conclusion For the majority of NSU cases, no bacterial cause was identified yet these men were all prescribed antibiotics. MG was detected in a third of persistent NSU cases but may account for more as 1g Azithromycin is enough to partially resolve symptoms but likely cause antimicrobial resistance. More effort should be made to determine the cause of urethritis in men so that appropriate antibiotics can be given where necessary.

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