Gonococcal and nongonococcal urethritis in men. Clinical and laboratory differentiation.

Abstract

The clinical and laboratory features of urethritis were studied in 400 symptomatic men at a venereal disease clinic. Most patients (54%) had nongonococcal urethritis; only 46% had gonococcal urethritis. In 85% of the cases, the Gram stain was read as unequivocally positive or negative; its accuracy in these cases was 98%. In 15% of the Gram stains, rare typical extracellular Gram-negative diplococci were intermingled with many atypical pleomorphic Gram-negative diplococci; in these cases cultures were essential for diagnosis. Patients with gonococcal urethritis usually had symptoms of both dysuria and discharge of short duration; patients with nongonococcal urethritis had variable symptoms of longer duration (P < 0.0005). Spontaneous purulent discharge was found only in patients with gonococcal urethritis. Most patients with nongonococcal urethritis had no discharge or mucoid discharge obtained only after penile stripping. These findings provide a basis for the rapid differential diagnosis of urethritis, which will permit immediate, definitive treatment for most men with urethritis.