Background This large series examines the behavioural, demographic and laboratory characteristics and pathogens among males with first presentation of acute NGU.
Methods Retrospective review using the electronic-medical record database of Melbourne Sexual Health Centre, Australia, from January 2006 to December 2011. Cases were men with their first presentation with symptoms of acute NGU, in this period. First-stream urine was routinely tested for C.trachomatis and M.genitalium by PCR, and selectively tested, for trichomoniasis by culture, and HSV-1/2, and adenoviruses by PCR. We examined characteristics of cases, stratifying by pathogen, pathogen-clusters and sexual preference.
Results Of 5452 cases of acute NGU during the study period, 4326 (79%) first presentations were included. 799(18.5%) had C.trachomatis,and 264(6.0%) M.genitalium detected. Of cases tested selectively on clinical grounds: 28/70 had adenovirus, 31/85 HSV-1/2 and 2/50 trichomoniasis. The majority (74.5%) had no pathogen-detected. Cases with bacterial-STIs were more likely than cases with viruses to have ≥ 5 PMNL/HPF on urethral Gram-stain (62.6% vs 31.5%),p < 0.001. Cases with viruses or no pathogen detected, were more likely to report unprotected oro-genital sex as their only exposure (10.3% & 10%,respectively) compared to cases with bacterial-STIs (5.2%),p < 0.001. Compared to heterosexuals, men who have sex with men (MSM) were less likely to have a bacterial-STI (OR = 0.5; 95% CI: 0.4–0.6, p < 0.001), more likely to have no pathogen-detected (OR = 1.9; 95% CI: 0.1.6–2.3, p < 0.001), and to report 100% condom-use (OR = 4.1; 95% CI: 3.5–4.9, p < 0.001).
Conclusion Compared to heterosexual men, MSM were less likely to have C.trachomatis and M.genitalium and more likely to have no pathogen detected in acute NGU. Cases with viral agents and pathogen-negative cases were significantly more likely to report unprotected oral sex as the only exposure, raising the possibility that other oropharyngeal pathogens may have an aetiologic role in acute NGU. The urethral Gram stain cut off ≥ 5 PMNL/HPF fails to detect a significant proportion of cases with bacterial and viral pathogens.
- non-gonococcal urethritis
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