Do all men attending departments of genitourinary medicine need to be screened for non-gonococcal urethritis?

Abstract

We investigated the influence of symptoms and signs on the detection of Chlamydia trachomatis, Mycoplasma genitalium and Ureaplasma urealyticum organisms (ureaplasmas) in men with non-gonococcal urethritis (NGU). Two hundred and forty-two men attending the Jefferiss Wing at St Mary's Hospital for a sexual health assessment were evaluated, of whom 169 had NGU. Urethral inflammation was diagnosed if there were either > or =5 polymorphonuclear leucocytes (PMNLs) per high-power field (HPF) in five or more microscope fields of a Gram-stained urethral smear, or > or =10 PMNLs per HPF in five or more fields of a Gram-stained thread from 15-20 mL of a first-passed urine (FPU) specimen. C. trachomatis was diagnosed by direct immunofluoresence, M. genitalium by a polymerase chain reaction assay and ureaplasmas by culture. On multivariate analysis, to control for potential confounding by age, ethnicity, sexual lifestyle and co-infection, an urethral discharge remained significantly associated with the detection of C. trachomatis and M. genitalium in men with acute urethritis [OR 12.3, 95% CI (2.39-63.5) and OR 35.2, 95% CI (3.9-319.6), respectively], but dysuria or penile irritation did not. The detection of ureaplasmas was not associated with any clinical feature. In addition, on multivariate analysis men with NGU who were either symptomatic or had an observable discharge were more likely to have C. trachomatis or M. genitalium detected [(OR 6.92, 95% CI 1.41-33.9) and (OR 5.18, 95% CI 0.99-27.1), respectively], but not ureaplasmas (OR 1.19, 95% CI 0.33-4.35). The findings suggest that in men with acute NGU, symptoms or signs, and in particular a urethral discharge, are associated with the detection of C. trachomatis and M. genitalium, but not ureaplasmas. Currently, there is no precise answer to the question of whether all men attending a GUM clinic need to be screened for NGU, but if clinically asymptomatic NGU is found not to be associated with a sexually transmitted pathogen, the UK clinical guidelines requiring the preparation of a urethral smear from such men would need to be revised.

Mycoplasma genitalium: from Chrysalis to Multicolored Butterfly

“…Among STD clinic populations, about 90% of M. genitalium-infected men have microscopic evidence of urethritis, and about three-quarters report symptoms, with a complaint of discharge being more common than in NGU of other etiologies (228). Indeed, there is evidence that M. genitalium is more closely associated with symptomatic than with asymptomatic NGU (14,82,87). Furthermore, the development and use of quantitative PCR assays for M. genitalium have shown greater M. genitalium DNA loads in urine from men with NGU than in urine from those without the disease (98,100).…”

Use of TaqMan 5′ Nuclease Real-Time PCR for Quantitative Detection of Mycoplasma genitalium DNA in Males with and without Urethritis Who Were Attendees at a Sexually Transmitted Disease Clinic

“…Several case-control studies of NGU patients and controls have confirmed this finding (for a review, see references 8 and 24). Subsequent studies have shown that M. genitalium is more closely associated with symptomatic urethritis than with asymptomatic urethritis (2; P. J. Horner and D. Taylor-Robinson, Letter, Lancet 343:790-791, 1994), particularly in those patients with an observable discharge (7). Recently, chronic NGU was also demonstrated to be associated with M. genitalium infection (5) The detection of M. genitalium in higher numbers in urogenital specimens from patients with NGU than in those without the condition would further strengthen the evidence that M. genitalium is a cause of NGU (22).…”

An Epidemiological Study of Mycoplasma genitalium Infections among Males Attending a Sexually Transmitted Disease Clinic in Guangxi, China

“…This is incongruous with prior relevant studies on MSP (5,16,28) and a report on men who have sex with men (MSM), which states that MSM with prior STIs were approximately 4-fold more likely to be infected with M. genitalium than those without (2). This may be due to the likelihood of patients ignoring mild STI symptoms and recall bias.…”