Effectiveness of syndromic management for male patients with urethral discharge symptoms in Amazonas, Brazil

Abstract

BackgroundUrethral discharge syndrome (UDS) is characterized by the presence of purulent or mucopurulent urethral discharge.The main etiological agents of this syndrome are Neisseria gonorrhoeae and Chlamydia trachomatis.ObjectivesTo evaluate the effectiveness of the syndromic management to resolve symptoms in male urethral discharge syndrome cases in Manaus, Amazonas, Brazil.MethodsRetrospective cohort of male cases of urethral discharge syndrome observed at a clinic for sexually transmitted disease (STD) in 2013. Epidemiological and clinical data, as well as the results of urethral swabs, bacterioscopy, hybrid capture for C.trachomatis, wet-mount examination, and culture for N.gonorrhoeae, were obtained through medical chart reviews.ResultsOf the 800 urethral discharge syndrome cases observed at the STD clinic, 785 (98.1%) presented only urethral discharge syndrome, 633 (79.1%) returned for follow-up, 579 (91.5%) were considered clinically cured on the first visit, 41(6.5 %) were considered cured on the second visit, and 13(2.0%) did not reach clinical cure after two appointments. Regarding the etiological diagnosis, 42.7% of the patients presented a microbiological diagnosis of N.gonorrhoeae, 39.3% of non-gonococcal and non-chlamydia urethritis, 10.7% of C.trachomatis and 7.3% of co-infection with chlamydia and gonococcus. The odds of being considered cured in the first visit were greater in those who were unmarried, with greater schooling, and with an etiological diagnosis of gonorrhea. The diagnosis of non-gonococcal urethritis reduced the chance of cure in the first visit.Study limitationA study conducted at a single center of STD treatment.ConclusionSyndromic management of male urethral discharge syndrome performed in accordance with the Brazilian Ministry of Health STD guidelines was effective in resolving symptoms in the studied population. More studies with microbiological outcomes are needed to ensure the maintenance of the syndromic management.

Diagnosing sexually transmitted infections in resource‐constrained settings: challenges and ways forward

“…Syndromic management for urethral discharge in men had sensitivities ranging from 84% to 95%. Treatment based on this syndrome is simple, inexpensive and cost‐effective . Apart from CT/NG, aetiologies include MG and TV .…”

“…The severity of symptoms associated with various STI pathogens and the anatomical sites infected greatly influence treatment‐seeking behaviour . Men with NG are frequently symptomatic whereas women with CT, NG and MG are frequently asymptomatic . Many syphilis cases occur without symptoms , as do many anal CT/NG infections .…”

Cluster analysis for symptomatic management of Neisseria gonorrhoea and Chlamydia trachomatis in sexually transmitted infections related clinics in China

“…Other studies also reported that urethral discharge syndromes can be a diagnostic symptom for the NG and CT in men, which was suggested as a cost-effective strategy ( 5 , 22 ). Similarly, the performance of urethral discharge syndromes for NG and CT infections has been adequate in other studies as well ( 23 , 24 ). The guidelines also recommended that if the urethral discharge is present but tests are negative, treatment for non-gonococcal and non-chlamydial urethritis (such as Mycoplasma genitalium or Trichomonas vaginalis ) should be considered ( 16 ).…”

Brazilian Protocol for Sexually Transmitted Infections, 2020: infections that cause urethral discharge

“…The treatment of urethral discharge can be performed through syndromic management for situations where there is no laboratory support 2 , 21 , 22 ( Figure 2 ). For cases of male urethral discharge, it is estimated that the syndromic management has a sensitivity ranging from 84% to 95% 23 .…”