Abstract
BackgroundInformation about the use of flow cytometry in the diagnosis of male urethritis is scarce. The current study aims to evaluate the performance of flow cytometry on first-voided urine in males with infectious urethritis (Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium and Trichomonas vaginalis).MethodsMale patients of the Andrology Centre (Tartu University Hospital, Estonia) were recruited during the period March 2015 –January 2018. Cases included 306 patients with infectious urethritis caused by Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium and/or Trichomonas vaginalis. The control group consisted of 192 patients without uro-genital complaints, negative tests for C. trachomatis, N. gonorrhoeae, M. genitalium and T. vaginalis from first-voided urine and no inflammation in first-voided urine, mid-stream urine and urine after prostate massage. C. trachomatis, N. gonorrhoeae, M. genitalium and T. vaginalis were detected from first-voided urine using polymerase chain reaction (PCR) method. First-voided urine was analysed using urine particle analyzer Sysmex UF-500i.ResultsThe most prevalent infection was chlamydia (64.1%), followed by Mycoplasma genitalium (20.9%), gonorrhoea (7.8%) and trichomoniasis (1.6%). Gonorrhoea caused the highest flow-cytometric leucocyte/bacteria count, followed by chlamydia and Mycoplasma genitalium. Trichomonas vaginalis showed nearly absent inflammation in first-voided urine. Using an empiric flow-cytometry diagnostic threshold for urethritis in first-voided urine (leucocytes ≥ 15/μl and bacteria ≥ 20/μl) the total calculated sensitivity was over 90%. However, when applying such criteria for deciding whether to perform first-voided urine PCR for C. trachomatis, N. gonorrhoeae, M. genitalium and T. vaginalis or not, we could miss 23 cases with infectious urethritis that makes up 7,5% of all proven cases.ConclusionsFlow cytometry of first-voided urine can be considered as a rapid and objective screening method in case of suspected male infectious urethritis.
Highlights
Transmitted infections (STI) affect the health of people worldwide causing several adverse consequences
The current study aims to evaluate the performance of flow cytometry on first-voided urine in males with infectious urethritis (Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium and Trichomonas vaginalis)
Using an empiric flow-cytometry diagnostic threshold for urethritis in first-voided urine the total calculated sensitivity was over 90%
Summary
Transmitted infections (STI) affect the health of people worldwide causing several adverse consequences. In recent years, new technologies have emerged in the field of urinalysis methodology, offering new quick and standardized opportunities in everyday clinical practice One of such technologies is urine particle flow cytometry that improves urine particles’ count precision and accuracy compared with conventional visual microscopy and offers significant labor reduction [5]. In a previous study we highlighted the symptomatology of STIs associated with urethritis and could not provide a detailed description of inflammatory reaction for each particular pathogen due to the shortcomings associated with urine dipstick analysis [8] This time we have aimed to find the optimal cut-off levels for triggering diagnostics of STIs associated with urethritis with the aim of improving the cost-effectiveness of the management of infectious urethritis for heterosexual men in a busy outpatient clinic. The current study aims to evaluate the performance of flow cytometry on first-voided urine in males with infectious urethritis (Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium and Trichomonas vaginalis)
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