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Genital infection with Chlamydia trachomatis (35–50%) is the single most identifiable cause of non-gonococcal urethritis (NGU) in heterosexual men and may have serious consequences, not only for men but for their partners. In India, a high prevalence of genital C trachomatis infection has been reported in women.1 However, there is considerably less information on male chlamydial infection.2,3 There is a definite need for reliable screening of C trachomatis genital infection in men in order to prevent underdiagnosis of genital chlamydial infection and to facilitate better clinical management of this infection in India. This study was undertaken with the aim to find the prevalence of C trachomatis infection in male patients with NGU attending the STD clinic of a major city hospital in north India.
After obtaining informed oral consent, 90 male patients (age 18–55 years) clinically suspected to have urethritis and attending the STD clinic at Safdarjang Hospital, New Delhi were enrolled. Of these, 85 NGU patients were included in the study on the basis of microscopic examination of urethral swab specimens for the presence of >10 polymorphonuclear neutrophils/high power field and negative results for Neisseria gonorrhoeae. None of the patients showed genital lesions. The patients belonged to various socioeconomic groups and the majority of them admitted to having extramarital heterosexual contact. The specimens were collected using sterile cotton tipped swabs (Hi Media, Mumbai, India) from the urethra of each patient after removing the secretions/discharge. The samples were collected in vials containing phosphate buffered saline for screening by a plasmid specific polymerase chain reaction (PCR) assay (517 bp)1 and confirmation by culture in McCoy cell line followed by direct fluorescent assay (DFA) (Microtitre, Syva Corporation, Palo Alto, CA, USA) on infected coverslips.4
Urethral C trachomatis infection was found by PCR (fig 1) and culture in 20 (22.3%) and 21 (24.7%) symptomatic male NGU patients, respectively. Further, chlamydial infection was most common (27.6%; statistically non-significant) in men in the 26–35 years age group. In an earlier hospital based study on male NGU patients reported from India, C trachomatis and Trichomonas vaginalis were the most common pathogens found by culture in urethral discharge specimens, being responsible for 18% and 19% cases, respectively.2 Another study from Chennai, India reported the prevalence of C trachomatis infection in male and female genital swab specimens as 18.9% and 32.2% by culture and PCR, respectively.3Chlamydia and Ureaplasma urealyticum were the most common infecting and co-infecting pathogens (51.5% by PCR in first void urine and 45.6% by culture in intraurethral swab specimens, respectively) in male patients with NGU attending an Israeli STD clinic.5 In a study from Turkey, the prevalence of C trachomatis and N gonorrhoeae (screened by ligase chain reaction in either urethral swabs or first void urine) among men with symptomatic urethritis was 15.7% and 9.4%, respectively.6 This should be viewed with concern particularly in developing countries like India where screening for C trachomatis is not done on a routine basis and, hence, extensive screening should be conducted for detection of genital C trachomatis infection in men using sensitive and specific molecular assays like PCR.
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