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• Mixed and mono-infections in non-gonococcal infections
  David Taylor-Robinson
  Published on: 23 August 2020

• Published on: 23 August 2020

  Mixed and mono-infections in non-gonococcal infections

  • David Taylor-Robinson, Retired Prof of Genitourinary Microbiology and Medicine Imperial College London

  The paper by Jordan SJ et al (1) is thought stimulating. The CDC guideline to regard 2-4 PMN/HPF as depicting NGU is possibly not widely observed, despite having been said 5 years ago (2). This and the inference that 1 or <1 PMN/HPF means no NGU must put a strain on those counting and poses the question of what variation might exist between observers.
  When 5 different micro-organisms were sought but not found in urethritis, the invitation was there to consider the role of oral and anal bacteria and those occurring in BV. An association between this and NGU has been noted in the past (3). Unfortunately it was not taken into account here. It is also curious that when looking at the role of Ureaplasma species, the authors did not consider U.parvum. Admittedly, others have considered it to be less important than U.urealyticum (4) but not banished it to the graveyard completely.
  Finally, the issue of bacterial load is important in considering pathogenicity. The authors state that they used quantitative PCRs but they did not provide ANY quantitative results. Why is that? These and longitudinal studies are required.
  I believe the conclusion of the authors is not fully founded. Remember, Koch's postulates have been fulfilled for U.urealyticum (5).
  REFERENCES
  1. Jordan SJ, Toh E, Williams AJ, et al. Aetiology and prevalence of mixed-infections and mono-infections in non-gonococcal urethritis in men: a case-control study. Sex Transm Inf 2020;...

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  The paper by Jordan SJ et al (1) is thought stimulating. The CDC guideline to regard 2-4 PMN/HPF as depicting NGU is possibly not widely observed, despite having been said 5 years ago (2). This and the inference that 1 or <1 PMN/HPF means no NGU must put a strain on those counting and poses the question of what variation might exist between observers.
  When 5 different micro-organisms were sought but not found in urethritis, the invitation was there to consider the role of oral and anal bacteria and those occurring in BV. An association between this and NGU has been noted in the past (3). Unfortunately it was not taken into account here. It is also curious that when looking at the role of Ureaplasma species, the authors did not consider U.parvum. Admittedly, others have considered it to be less important than U.urealyticum (4) but not banished it to the graveyard completely.
  Finally, the issue of bacterial load is important in considering pathogenicity. The authors state that they used quantitative PCRs but they did not provide ANY quantitative results. Why is that? These and longitudinal studies are required.
  I believe the conclusion of the authors is not fully founded. Remember, Koch's postulates have been fulfilled for U.urealyticum (5).
  REFERENCES
  1. Jordan SJ, Toh E, Williams AJ, et al. Aetiology and prevalence of mixed-infections and mono-infections in non-gonococcal urethritis in men: a case-control study. Sex Transm Inf 2020; 306-11.
  2. Workowski KA, Bolan GA, Papp JR. Sexually transmitted disease treatment guidelines, 2015.MMWR Recomm Rep 2015; 64: 1-137.
  3. Keane FE, Thomas BJ, Whitaker L, et al. An association between non-gonococcal urethritis and bacterial vaginosis and the implications for
  patients and their sexual partners. Genitourin. Med 1997; 73: 373-7.
  4. Zhang N, Wang R, Li X, et al. Are Ureaplasma spp. a cause of nongonococcal urethritis ? A systematic review and meta-analysis. PLoS One
  2014; 9: e113771.
  5. Taylor-Robinson D, Csonka GW, Prentice MJ. Human intra-urethral inoculation of ureaplasmas. Quart J Med 1977; 183: 309-26.

  David Taylor-Robinson

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  Conflict of Interest:
  None declared.

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