Abstract
BackgroundMale urethritis is primary sexually transmitted. Northern Territory (NT) has the highest rates of gonococcal infection in Australia and local guidelines recommend empiric treatment with azithromycin and ceftriaxone for all men presenting with urethritis. As gonococcal drug resistance is a growing concern, this study aims to improve empiric use of ceftriaxone through examining local patterns of male urethritis, comparing cases of gonococcal urethritis (GU) to controls with non-gonococcal urethritis (NGU).MethodsA retrospective study was undertaken of all men with symptomatic urethritis presenting to Darwin sexual health clinic from July 2015 to July 2016 and aetiology of urethritis in this population was described. Demographic, risk profile, and clinical features of GU cases were compared to NGU controls.ResultsAmong n = 145 men, the most common organisms identified were Chlamydia trachomatis (23.4%, SE 3.5%) and Neisseria gonorrhoeae (17.2%, SE 3.1%). The main predictors of GU were any abnormalities on genital examination (aOR 10.4, 95% CI 2.1 to 50.8) and a history of urethral discharge (aOR 5.7, 95% CI 1.4 to 22.6). Aboriginal patients (aOR 3.0, 95% CI 0.9 to 9.6) and those over 30 years of age (aOR 1.4, 95% CI 0.3 to 7.0) were more likely to have GU in the unadjusted analysis, but not in the adjusted model.ConclusionThis is the first study looking at patterns of male urethritis in urban NT and the results support a move towards adopting national guidelines to use ceftriaxone for empiric management of syndromic urethritis only in high-risk patients. In addition to traditional demographic risk factors, clinical features remain an important component of risk stratification.
Highlights
Transmitted infections account for the majority of male urethritis and symptoms include urethral discharge, irritation and dysuria
This study describes the aetiology of male urethritis in urban Northern Territory (NT) and compares the demographics, risk profiles and clinical features of men with gonococcal urethritis (GU) to those with non-gonococcal urethritis (NGU)
Participants Amongst all men treated with azithromycin and ceftriaxone at the clinic between July 2015 to July 2016, 39 cases were excluded on basis of being treated for asymptomatic infections, 15 were excluded due to nonurethral symptomatic infections and 8 duplicate presentations were excluded (Fig. 1)
Summary
Transmitted infections account for the majority of male urethritis and symptoms include urethral discharge, irritation and dysuria. In Australia, rates of gonococcal isolates with decreased susceptibility to ceftriaxone (MIC of > = 0.06) have been recorded as high as 8.8% in 2013, and azithromycin resistance (MIC > = 1.0 mg/L) is on the rise [4]. Of national concern in Australia is the detection of two cases of multi-drug resistant gonococcal isolates in early 2018 [5]. Northern Territory (NT) has the highest rates of gonococcal infection in Australia and local guidelines recommend empiric treatment with azithromycin and ceftriaxone for all men presenting with urethritis. As gonococcal drug resistance is a growing concern, this study aims to improve empiric use of ceftriaxone through examining local patterns of male urethritis, comparing cases of gonococcal urethritis (GU) to controls with non-gonococcal urethritis (NGU)
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