We investigated the prevalence of various genital organisms in 268 men with (cases) and 237 men without (controls) urethral symptoms/signs (urethral discharge, dysuria and/or urethral irritation) from two sexual health clinics in Sydney between April 2006 and November 2007. The presence of urethral symptoms/signs was defined as non-gonococcal urethritis (NGU) for this study. Specific aims were to investigate the role of Ureaplasma urealyticum in NGU and the prevalence of Mycoplasma genitalium in our population. Multiplex polymerase chain reaction-based reverse line blot (mPCR/RLB) assay was performed to detect 14 recognized or putative genital pathogens, including Chlamydia trachomatis, M. genitalium, U. urealyticum and U. parvum. U. urealyticum was associated with NGU in men without another urethral pathogen (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.1-3.8; P = 0.04); this association remained after controlling for potential confounding by age and history of unprotected vaginal sex in the last four weeks (OR 2.0, 95% CI: 1.1-3.9; P = 0.03). C. trachomatis (OR 7.5, P < 0.001) and M. genitalium (OR 5.5, P = 0.027) were significantly associated with NGU. The prevalence of M. genitalium was low (4.5% cases, 0.8% controls). U. urealyticum is independently associated with NGU in men without other recognized urethral pathogens. Further research should investigate the role of U. urealyticum subtypes among heterosexual men with NGU.

The aim of this study was to develop and evaluate a sensitive method for the simultaneous identification of 14 urogenital potential pathogens. A multiplex PCR-based reverse line blot (mPCR/RLB) assay was developed to detect 14 urogenital pathogens or putative pathogens, namely Trichomonas vaginalis, Streptococcus pneumoniae, Neisseria gonorrhoeae, Chlamydia trachomatis, Ureaplasma parvum, U. urealyticum, Gardnerella vaginalis, Haemophilus influenzae, herpes simplex virus type 1 (HSV1) and HSV2, N. meningitidis, Mycoplasma hominis, M. genitalium, and adenovirus, using two species-specific primer pairs and probes for each. The method was validated using a reference strain or a well-characterized clinical isolate of each target organism and was found to be both sensitive and specific. The limits of detection for the mPCR/RLB assay varied among the 14 target organisms from 4.2 ؋ 10 ؊1 to 7.0 ؋ 10 ؊11 ng/l of genomic DNA. There were no cross-reactions among any of the probes. This method was used to test 529 first-voided urine specimens from male patients with and without urethritis attending two Sydney sexual health clinics. One or more target species were detected in 193 (36%) subjects. Of 233 positive results, overall 216 (93%) were concordant between mPCR/RLB and a comparator method (culture and/or species-specific PCR), 9 were positive only by mPCR/RLB, and 8 were positive only by the comparator method. The mPCR/RLB method was an accurate, convenient, and inexpensive method for the detection of multiple potential pathogens in first-voided urine specimens from men.Sexually transmitted infections (STIs) are a major global health problem. Worldwide, an estimated 340 million cases of curable STIs, including chlamydial infection, gonorrhea, trichomoniasis, and syphilis, occur annually, and their incidence is increasing in many parts of the world. In developing countries, their complications rank in the top five disease categories for which adults seek health care (www.who.int /mediacentre/factsheets/fs110/en/). Many STIs cause asymptomatic infection; for example, up to 70% of men and women with gonococcal and/or chlamydial infections are symptom free (www.who.int/mediacentre/factsheets/fs110/en/), which creates the potential for unrecognized transmission with significant implications for both individual and population health.Urethritis is characterized by discharge and dysuria (37) and is broadly classified as nongonococcal (NGU) or gonococcal. It occurs in both men and women but often is unrecognized in women. Acute NGU is one of the commonest STIs affecting heterosexual men, yet a specific pathogen, most commonly Chlamydia trachomatis, is identified in only 50 to 70% of cases (7). Pelvic inflammatory disease is an important complication of STI in women; C. trachomatis and N. gonorrhoeae commonly are implicated, but often the cause is unknown. Bacterial vaginosis is the commonest cause of vaginal discharge and is associated both with recognized STIs and other genital syndromes (3,18). Additional epidemiological stud...

Objectives: To ascertain how frequently Australian general practitioners (GPs) identify sexual health (SH) problems, to gain understanding of how SH problems are managed in general practice and to determine the characteristics of GPs who manage them. Methods: A secondary analysis of data from the BEACH programme April 2000-March 2003. BEACH is a cross sectional national survey of GP activity: approximately 1000 GPs per year, each records details of 100 consecutive patient encounters. Initially, patient reasons for encounter (RFE), suggestive of a SH problem, were used to derive a list of SH problems (that is, doctor's diagnosis/problem label). Management of these problems was then investigated for all encounters with patients aged 12-49 years. The frequency of SH problems, their management and the characteristics of GPs managing them, were analysed using SAS. Results: During 299 000 encounters with 2990 GPs, 3499 (1.17 per 100 encounters) STI/SH problems were managed, the majority (81.1%) in females. The most common in women were genital candidiasis, vaginal symptoms, urinary symptoms, and intermenstrual bleeding, and in men were testicular symptoms, genital warts, and urethritis. Tests to exclude specific STIs were seldom taken and symptomatic management was common. GPs managing SH problems were younger, more likely to be female, have fewer years in practice, work in larger practices; hold FRACGP status (all p = ,0.001) than those GPs who managed none. Conclusion: Patients seeking medical attention for SH problems are often managed by GPs. Tests to diagnose or exclude specific sexually transmitted infections are seldom ordered and symptomatic management is common. Strategies to improve management of SH problems in general practice need to be developed and evaluated.