Co-Infection with Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis in Symptomatic South African Men with Urethritis: Implications for Syndromic Management

Abstract

Abstract:Background: This study was undertaken to determine co-infection rates of common aetiological agents of urethritis and information regarding sexual contacts of symptomatic males presenting to a family practitioner. Methods: Endo-urethral swab specimens were collected from 253 symptomatic men and tested for N. gonorrhoeae, C. trachomatis by the BD ProbeTec ™ ET assay and for T. vaginalis by real-time PCR. Information regarding sexual behaviour was collected by the practitioner using a structured interview. Results: Of the 253 patients investigated, 50 complained of urethral discharge with/without burning on micturition (BOM), the remaining 203 only complained of BOM. N. gonorrhoeae was isolated from 45%, C. trachomatis from 15% and T. vaginalis from 5.5%. N. gonorrhoeae/C. trachomatis co-infection was diagnosed in 7.5% and T. vaginalis was detected in a higher number of males presenting without visible discharge. Similar number of men reported sexual contact only with their wives compared to men having casual sexual contacts. There were fewer gonococcal infections in men reporting sexual contact with their wives alone compared to men reporting casual sexual encounters. Conclusions: Treatment guidelines for men presenting to Primary Health Care facilities and Family Practitioners need to consider the evolving antimicrobial resistance profiles and the presence of mixed infections in symptomatic patients.

Chlamydia Trachomatis in Non-Specific Urethritis

“…Other bacteria involved in UTI were identified in order to establish the fact that infection were actually caused by multiple organism. De Jongh et al (2009) screened 253 males with urethritis using PCR for Chlamydia trachomatis, Neisseria gonorrheae and Trichomonas vaginalis where they reported 15% positive samples for Chlamydia trachomatis and 7.5% co-infection with Neisseria gonorrheae in South African males a result similar with the one observed in this study though with a higher positive result which is also a reflection of lack of screening for Chlamydia trachomatis and most probably because they screened only males. Complement fixation test though cumbersome and not very specific for Chlamydia trachomatis because of the group reactive antigen of Chlamydia spp still remains one of the most reliable serological tests (Okoror, 2010 Age is a factor to UTI especially as it involves the early age groups with lesser number as well as lower percentage of individuals with UTI and also non-specific urethritis involving Chlamydia trachomatis as most individuals in this age group are not yet sexually active.…”

Aetiological agents of urethritis in symptomatic South African men attending a family practice

“…In previous studies in Pretoria, N. gonorrhoeae was found in 39.0% and 44.7% of men with urethritis. 18,31 Furthermore, it ought to be noted that in the current study the number of patients with visible discharge was smaller than those with symptoms of only BOM.…”

“…Multiple infections in men with urethritis have been reported previously in South Africa. 17,18,30 In this study, multiple infections were seen in 9.3% of patients, with a combination of N. gonorrhoeae and M. genitalium being the most common combination.…”

“…There could be other causes of urethral symptoms and it has been shown that in a fair number of symptomatic men no recognized pathogen is detected. 18 In a study by Bradshaw et al 19 it was shown that 38% and 44% of men infected with adenovirus and herpes simplex virus (HSV), respectively, had fewer than 5 PMNLs/hpf.…”

Sexually Transmitted Infections in Women Participating in a Biomedical Intervention Trial in Durban: Prevalence, Coinfections, and Risk Factors

“…Swygard et al [ 17 ] reported coinfection rates between CT and TV to be 15–28% in the USA. In South Africa, coinfection rates for CT and TV have only been reported in men with urethritis [ 18 ] and pregnant women [ 19 ], thereby limiting the comparison of our study data with other reports from South Africa. To the best of our knowledge, our data is novel in nonpregnant women and suggests that younger women whether pregnant or not have a higher prevalence of STIs.…”