Asymptomatic Gonorrhea in Men

Handsfield, H. Hunter; LIPMAN, TIMOTHY O.; Harnisch, James P.; Tronca, Evelyn; Holmes, King K.

doi:10.1097/00006254-197408000-00014

Cited by 8 publications

(8 citation statements)

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“…Of the 1338 participants, 63% were male marines and 37% were female navy personnel. Compared with asymptomatic gonorrhea of Ç2% [14]. However, the rate of gonorrhea in the United States has dramatically declined from men, women were, on average, a younger population (22 vs. 26 years), were more junior in enlisted grade (72% vs. 28% ú450 cases/100,000 population in 1975 to 124 cases/100,000 population in 1996 [1].…”

Section: Sexually Transmitted Diseases (Stds) Continue To Be a Highmentioning

confidence: 99%

Asymptomatic Sexually Transmitted Disease Prevalence in Four Military Populations: Application of DNA Amplification Assays forChlamydiaand Gonorrhea Screening

Brodine¹,

Shafer²,

Shaffer³

et al. 1998

J INFECT DIS

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The prevalence of asymptomatic chlamydial and gonococcal infections in male and female military populations was determined using urine-based ligase chain reaction DNA amplification assays (DAAs). Cross-sectional surveys in four military settings revealed an overall prevalence of asymptomatic chlamydial infection of 4.2% (56/1338). This included 3.4% (21/618) of Western Pacific shipboard US Marine Corps enlisted men; 5.2% (21/406) of male marines shore-based in Okinawa, Japan; 2.7% (5/183) of female enlisted US Navy subtender personnel in dry dock; and 6.9% (9/131) of shore-based female naval personnel in San Diego. No gonococcal infections were detected. All subjects were treated within 2 weeks of screening; none of them had progressed to symptomatic disease. General population-based screening for asymptomatic sexually transmitted diseases, and in particular chlamydial infection, can be successfully implemented using urine-based DAA tests. Benefits are maximized in a population in which compliance for follow-up therapy is high. Sexually transmitted diseases (STDs) continue to be a highA new era in chlamydial detection and control has emerged with the recent licensure of the DNA amplification assays source of morbidity and costs for young adults [1]. Chlamydia trachomatis is the most common bacterial STD in the United (DAAs), ligase chain reaction (LCR) and polymerase chain reaction (PCR). The sensitivity (90% -99%), specificity (99% -States, with an estimated 4 million infections occurring annually, costing several billion dollars [2]. Morbidity is especially 100%), and positive predictive value of these assays are very high when applied to genital specimens. The sensitivity is high in women; sequelae include pelvic inflammatory disease, infertility, ectopic pregnancy, and the potential for neonatal greater than the previous reference standard of tissue culture. Importantly, the performance of DAAs to detect Chlamydia transmission [3]. The introduction of noninvasive Chlamydia antigen detection tests, such as EIAs of urine, represented a organisms and gonorrhea in the urine of both women and men (88% -96% sensitivity) is similar to the performance of these major advance for the detection of symptomatic and asymptomatic infection in men [4]. However, the sensitivity of these assays on urethral and endocervical swabs from symptomatic and asymptomatic women and men [2, 5, 6]. The DAAs permit, assays in the urine of infected women is suboptimal, ranging from 35% to 40%, and requires an endocervical swab for EIA for the first time, accurate documentation of asymptomatic chlamydial and gonococcal infection rates in various populascreening and diagnosis [5].tion groups with an easily applied noninvasive urine test. In addition, serial PCR sampling following antibiotic therapy doc-

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Section: Sexually Transmitted Diseases (Stds) Continue To Be a Highmentioning

confidence: 99%

Asymptomatic Sexually Transmitted Disease Prevalence in Four Military Populations: Application of DNA Amplification Assays forChlamydiaand Gonorrhea Screening

Brodine¹,

Shafer²,

Shaffer³

et al. 1998

J INFECT DIS

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“…These figures are similar to those of other reports. 5 These are considered to be more specific, using antibody to detect gonococci and a bright green label bonded onto this to make them stand out in the visual field. The technique originally7 received favourable reports, but some found it to be little better than a Gram stained smear and discussed theoretical disadvantages.…”

mentioning

confidence: 99%

Microbiological diagnosis of gonorrhoea.

Jephcott¹

1997

Sexually Transmitted Infections

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“…The discovery that a significant number of asymptomatic men are infected and may be transmitting disease to others was made only because male contacts of infected women were traced and brought to examination.7 8 Handsfield, in a recent study, found that as many as 40 per cent of the male contacts of women with pelvic inflammatory disease were bacteriologically positive, albeit asymptomatic, and reinfecting their partners. 9 If we are ever to bring this epidemic under control, health providers must improve the quality of their diagnoses, report diagnosed cases more faithfully, manage them more appropriately using the most effective treatment regimes, and insure that both male and female cases return for posttreatment culture. Providers must be made aware that failure to conduct contact investigation as part of the management of an infected patient can incur the risk of malpractice charges as surely as neglect of the patient in other areas of patient care.9 Only through better epidemiological practice and sounder patient management can we hope to make a significant impact on the current epidemic of gonorrhea.…”

Section: Containing the Gonorrhea Epidemicmentioning

confidence: 99%

Containing the gonorrhea epidemic.

Roberts¹

1978

Am J Public Health

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figure-probably an underestimate-is impressive in terms of both dollars and cents and human suffering.The problem of non-recognition and the reluctance of physicians to report gonorrhea have been long-standing concerns to public health officers charged with responsibility for the control of this and other venereal diseases. Following the onset of the penicillin era, many primary care physicians became less sensitive to the potential seriousness of gonorrhea in the adult and even less inclined to report the cases they treated. Possibly this trend was accentuated by the fact that the majority of the cases they saw were uncomplicated and the patients themselves assumed that cure was an easy matter. By the very nature of the symptomatology, patients seriously ill with complications of gonococcal infection-such as arthritis, endocarditis, meningitis, the Fitz-Hugh-Curtis syndrome, or one of the many other manifestations of disseminated disease-seek care in the emergency rooms of hospitals or from specialist physicians. Here again, once Neisseria gonorrhoeae has been identified as the underlying culprit, reporting the disease and tracing the contacts may be ignored.There are no effective vaccines currently available against the venereal diseases. Hence accurate, complete reporting and diagnosis, adequate treatment, follow-up of cases, and the tracing of contacts are the pivotal components of a public health program to fulfill mandated responsibilities for their control and prevention. In this context the findings reported from the state of Washington are distressing. Whether identified in the private or public sector of the health care system, timely information on incidence and prevalence is essential to the development and execution of control measures and the monitoring of their effectiveness. Effective care for the patient with urethritis and the prevention of disease transmission require as definitive a diagnosis as possible prior to treatment, the use of appropriate medication in fully therapeutic doses, and post-treatment follow-up. Penicillinase producing N. gonorrheoae (PPNG) are identified primarily through post-treatment follow-up with test-of-cure culture.Effective contact tracing for control and prevention depends upon as high a level of reporting as possible. The discovery that a significant number of asymptomatic men are infected and may be transmitting disease to others was made only because male contacts of infected women were traced and brought to examination.7 8 Handsfield, in a recent study, found that as many as 40 per cent of the male contacts of women with pelvic inflammatory disease were bacteriologically positive, albeit asymptomatic, and reinfecting their partners.9

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Asymptomatic Gonorrhea in Men

Cited by 8 publications

References 0 publications

Asymptomatic Sexually Transmitted Disease Prevalence in Four Military Populations: Application of DNA Amplification Assays forChlamydiaand Gonorrhea Screening

Asymptomatic Sexually Transmitted Disease Prevalence in Four Military Populations: Application of DNA Amplification Assays forChlamydiaand Gonorrhea Screening

Microbiological diagnosis of gonorrhoea.

Containing the gonorrhea epidemic.

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