Diagnosis Of Non-gonococcal Urethritis Research Articles

Evaluating the utility of the A.F. Genital System test for pathogen diagnosis in acute male urethritis.

This study evaluated the effectiveness of the A.F. Genital System (Liofilchem® , Italy) in detecting pathogens compared with multiplex real-time polymerase chain reaction (PCR) in men with acute urethritis. Men diagnosed as having acute urethritis between 1 April 2021 and 31 December 2021 were included. Urethral swab samples were obtained for A.F. Genital System and PCR testing in a randomly determined order. The efficacy of the A.F. Genital System was analysed by comparing the results of the two tests. The study included 83 patients (mean age 34.1±11.3years). A urethritis pathogen was detected in 69 patients (83.1%) by PCR and only 15 patients (18.1%) with the A.F. Genital System. The sensitivity of the A.F. Genital System in detecting acute urethritis pathogens was 21.7% (95% confidence interval [CI]: 13.6-32.8), and the specificity was 100% (95% CI: 78.5-100). Its sensitivity was 20% (95% CI: 7.1-45.2) in the diagnosis of gonococcal urethritis and 19.1% (95% CI: 11.2-30.4) in the diagnosis of non-gonococcal urethritis. PCR detected two or more urethritis pathogens in 9 patients (13.0%), while no polymicrobial infection was detected with the A.F. Genital System. Based on the results of multiplex real-time PCR, the A.F. Genital System had very low sensitivity in the detection of pathogens in acute male urethritis. It should be kept in mind that using this test in patients with acute urethritis may result in a high missed diagnosis rate for urethritis pathogens.

Resolution of Symptoms and Resumption of Sex After Diagnosis of Nongonococcal Urethritis Among Men Who Have Sex With Men.

Standard counseling at nongonococcal urethritis (NGU) diagnosis includes advice to abstain from sex for at least 7 days and until symptoms resolve. From December 2014 to July 2018, we enrolled men who have sex with men and received azithromycin (1 g) for NGU at the Public Health-Seattle and King County STD Clinic. Over 12 weeks of follow-up, participants reported daily urethral symptoms and sexual activity on web-based diaries. Nongonococcal urethritis was defined as urethral symptoms or visible urethral discharge plus 5 or greater polymorphonuclear leukocytes per high-power field. Time of symptom resolution was defined as the first of 5 consecutive asymptomatic days. Of 100 participants with NGU and no Chlamydia trachomatis (CT)/Mycoplasma genitalium (MG) coinfection, 36 (36%), 22 (22%), and 42 (42%) had CT-NGU, MG-NGU, and non-CT/non-MG NGU, respectively. Among men with MG-NGU, 94% had a macrolide resistance mutation. For all etiologies, median time to symptom resolution after azithromycin was 7 days (95% confidence interval [CI], 5-9); 37% had symptoms lasting longer than 7 days. For men with CT-NGU, MG-NGU, and non-CT/non-MG NGU, median time to symptom resolution was 4 days (95% CI, 2-6; 16% >7 days), undefined days (95% CI, 7 to undefined; 60% >7 days), and 7 days (95% CI, 5-11; 46% >7 days), respectively. Median time to first sexual activity (any type) was 12 days (95% CI, 11-17); it was 16 days (95% CI, 12-18) to first urethral sexual exposure. Twenty-seven percent did not avoid urethral exposure for the recommended period. Counseling at NGU diagnosis should educate patients that symptoms may persist more than 7 days, particularly for non-CT NGU, and emphasize the rationale for the 7-day abstinence period.

Microscopy of Gram-stained urethral smear in the diagnosis of urethritis: Which threshold value should be selected?

The aim of this study was to investigate the sensitivity of GSS in the diagnosis of urethritis in patients who present to the outpatient clinic with symptoms of urethritis. Sixty-three male patients who presented to our outpatient clinic with symptoms of urethritis between January and March 2018 were evaluated. Urethral smear samples obtained from patients were evaluated both by GSS examination and by Real-time Multiplex Polymerase Chain Reaction (rt-MPCR) assay. The sensitivity and specificity of GSS in detecting gonococcal urethritis (GU) and nongonococcal urethritis (NGU) were calculated for threshold values of ≥5 and ≥2 PMNL/HPF. The mean age was 33.2±7.1years. According to the rt-MPCR results, 14 patients had GU and 27 patients had NGU. A threshold value of ≥5 PMNL/HPF in the GSS demonstrated 92.9% sensitivity in the diagnosis of GU and 55.6% sensitivity in the diagnosis of NGU. A threshold value of ≥2 PMNL/HPF reached 100% sensitivity for GU and 92.6% sensitivity for NGU. A cut-off value of ≥5 PMNL/HPF in the GSS has low sensitivity in the diagnosis of NGU. On the other hand, a threshold value of ≥2 PMNL/HPF seems to have higher sensitivity in the diagnosis of both GU and NGU.

Mycoplasma genitalium in the Far North Queensland backpacker population: An observational study of prevalence and azithromycin resistance.

BackgroundMycoplasma genitalium is a sexually transmitted infection (STI), and a common cause of non-gonococcal urethritis (NGU). There is concern regarding the rise in prevalence of M. genitalium and rates of resistance to macrolide antibiotics. International backpackers represent a unique population that may be at an increased risk of STIs. The purpose of this study was to determine the prevalence of M. genitalium and antibiotic resistance in international backpackers.MethodsFirst void urine samples were obtained utilising opportunistic sampling from 294 non-treatment-seeking international backpackers at a variety of hostels in Cairns, Queensland Australia. Participants also answered a fixed-answer survey regarding sociodemographic characteristics and sexual risk behaviours. Samples were tested for M. genitalium, Chlamydia trachomatis and Neisseria gonorrhoeae using polymerase chain reaction (PCR). Samples positive for M. genitalium were investigated for macrolide resistance-associated mutations in the 23S rRNA genome at positions A2058G, A2058C, A2058T, A2059G and A2059C (Escherichia coli numbering).ResultsOf the 294 samples, 23 failed the internal control. The prevalence of M. genitalium was 1.8% (5/271, 95% confidence interval [CI] ± 1.58), C. trachomatis was 4.1% (11/271, 95% CI ± 2.36) and N. gonorrhoeae was not detected. Macrolide resistance-associated mutations were identified in 40% (2/5) of M. genitalium-positive samples. M. genitalium infection was associated with reporting symptoms (odds ratio [OR] 14.36, 95% CI 2.17–94.94, p < 0.05).ConclusionsM. genitalium and C. trachomatis are relatively common amongst non-treatment seeking international backpackers, but may not differ from Australian population prevalence. This article provides evidence to further support the increased utilisation of M. genitalium PCR in the diagnosis of NGU, and for macrolide resistance testing for all identified M. genitalium infections.

Audit of treatment and contact-tracing rates in immediate (presumptive) versus delayed (polymerase chain reaction) diagnosis of chlamydial infection

An audit of all cases of chlamydial infection diagnosed in men at the Edinburgh genitourinary (GU) medicine clinic over a six-month period from January 2003 is reported. In all, 189 men identified as requiring treatment for possible chlamydial infection on first attendance (because of contact with a partner with chlamydia or the diagnosis of non-gonococcal urethritis [NGU] on microscopy), who later proved chlamydia-positive by polymerase chain reaction (PCR), were compared with 83 men in whom infection was identified only on receipt of a PCR result. Treatment rates were 100% in the first group and 97.6% in the second group (chi(2) 0.046, P<0.05). In men presumptively diagnosed and treated, 88.6% of contacts identified were confirmed as traced, compared with 90% confirmed as traced in the group diagnosed by PCR alone. Our audit suggests that identifying men with chlamydial NGU by routine microscopy may carry a small but significant advantage in increasing treatment rates, but makes no difference to contact-tracing success rate.

The value of testing urine in non-gonococcal urethritis

This audit was conducted to look into the necessity of testing urine threads, in the diagnosis of non-gonococcal urethritis (NGU). In a sample of 280 NGU cases, it was found that in 8.8% of cases there was a risk of the diagnosis being missed, should Gram-stained urethral smears be totally relied on. The study showed that examining urine threads is beneficial in diagnosing NGU, especially, in symptomatic men with negative Gram-stained urethral smears. It should be noted, however, that in the group of patients studied for this audit, urine threads testing did not detect any chlamydia-positive NGU cases.

Asymptomatic non-chlamydial, non-gonococcal urethritis &mdash; an iatrogenic disease?

Around the middle of the twentieth century, specialist services began routinely screening asymptomatic men with a urethral smear for gram staining. The practice persists in over 90% of United Kingdom services in line with national guidelines.1 If the smear reveals ≥5 polymorphs in five or more oil-immersion fields then a diagnosis of non-gonococcal urethritis (NGU) is made, despite the absence of symptoms or a specific pathogen. Some will even fish out threads or debris from an asymptomatic man’s first-void urine and stain these, in this case looking for ≥10 polymorphs/oil-immersion field. An alternative is a leucocyte esterase test on the urine. Thus (arbitrarily) a new disease was created; necessitating counselling, antibiotic treatment, contact tracing, and frequent psychosocial dilemmas. The Americans generally go easy on the tracing of contacts of cases of asymptomatic NGU in the absence of a specific organism (C. trachomatis) being documented.2 While agreeing on the microscopic criteria for asymptomatic urethritis, in contrast to the UK neither the American nor the Australian guidelines advocate urethral smears for microscopy for asymptomatic men, though neither guidelines actually advise against the practice.3,4 Perhaps technology has advanced to the point where this time-consuming and often problematic diagnosis of asymptomatic non-chlamydial, non-gonococcal urethritis (NCNGU) (and its active pursuit in the clinic) needs to be reappraised. First, we need to ask why did the practice start in the first place? After glancing over their shoulders, a few senior UK genitourinary physicians have intimated their sceptical view that the process was devised ‘to keep the statistics up in the clinics’. By the 1950s, the introduction of penicillin had made large inroads into the major concerns of the time — gonorrhoea and syphilis. The tactic worked. NGU filled the gap and the comprehensive network of UK clinics was preserved. In the meantime, in the USA, the practice did not become as widespread and much of their clinical network was de-funded. But these days the UK clinics are straining under a massive and growing clinical burden— yet more reason to question a traditional practice with a fading rationale. Second, therewas a strong hunch (confirmed by the 1970s) that NGU often indicated an important infection (namely C. trachomatis) with serious consequences for sexual partners, and chlamydial urethritis is commonly asymptomatic. At the time (in the absence of any other test for C. trachomatis infection) this provided a compelling argument for screening for asymptomatic NGU. However, these days, a specific test for C. trachomatis is part of the routine work-up in specialist services,1 so all the urethral smear now contributes is the diagnosis of asymptomatic NCNGU. Additionally, as control programmes take effect, C. trachomatis tends to contribute shrinking proportions (typically< 20%) of acute NGU cases and even smaller proportions of asymptomatic NGU cases.2 The only consistently documented causes of NCNGU are Mycoplasma genitalium5 and Trichomonas vaginalis6 [the latter largely confined to areas of high prevalence (Table 1)] but we don’t routinely test for these organisms. The reasons that we don’t screen for these infections are because the pathogenicity ofM. genitalium has been unclear until recently5 while T. vaginalis tends to be uncommon in those services that can afford to test for it. There may be a scattering of other specific causes of NCNGU (Table 2)7−11 but there is no debate that we don’t know the cause of most cases. Thus we find ourselves in the odd predicament of having constructed and been required to manage an asymptomatic condition with generally no known cause and no known consequences. Some may chose to continue the practice of urethral smears with the justification that a sinister (as yet undiscovered) pathogen is lurking in the urethrae of thesemen and that they wouldn’t otherwise get treated. But the treatments most commonly used for NGU or NCNGU in the public sectors in the UK and the USA (tetracyclines) have no effect on T. vaginalis and, on preliminary experience, a

Poor sensitivity and consistency of microscopy in the diagnosis of low grade non-gonococcal urethritis

Objectives: To determine the reliability of the diagnosis of non-gonococcal urethritis (NGU), and the variation between and within microscopists, from urethral smears at a large London genitourinary medicine clinic. Methods:...

Diagnosing Non-Gonococcal Urethritis: The Gram-Stained Urethral Smear in Perspective

The value of microscopy of a Gram-stained urethral smear in the diagnosis of non-gonococcal urethritis and chlamydial urethral infection was assessed in 153 men attending a department of genitourinary medicine. A mean of more than 4 polymorphs in 5 fields (x1000) was considered to be abnormal. In the diagnosis of urethritis, the sensitivity (94%), specificity (91%), positive predictive value (93%) and negative predictive value (93%) were high. In the diagnosis of chlamydial infection, sensitivity (91%) and negative predictive value (96%) were high, but specificity (68%) and positive predictive value (46%) were low. In men with symptoms of genitourinary infection, the sensitivity (96.7%) and negative predictive value (97.4%) of the Gram-stained urethral smear in the diagnosis of chlamydial infection was comparable with modern chlamydial antigen detection tests.

A CLINICAL STUDY OF STD (SEXUALLY TRANSMITTED DISEASE) IN GUNMA UNIVERSITY HOSPITAL AND 4 AFFILIATED HOSPITALS

We investigated STD patients who visited our outpatient department or 4 affiliated hospitals for a period from January 1987 to June 1987.The number of patients was 255 (235 males and only 20 females). The most frequent STD was NGU (nongonococcal urethritis). Next was GU (gonococcal urethritis). A diagnosis of NGU was adopted when Neisseria gonorrhoeae could not be detected by routine stain or culture. Chlamydia trachomatis was detected in 1 (14.3%) of 7 patients with GU, and in 20 (51.3%) of 49 patients with NGU.Staphylococcus epidermidis was the most frequent species isolated from the urethral smears of the urethritis patients.

Leucocyte esterase test as rapid screen for non-gonococcal urethritis.

The two standard tests for the initial diagnosis of non-gonococcal urethritis (NGU), microscopic examination of gram stained urethral smears and the two glass urine test, have the disadvantage of being insensitive and subjective. The leucocyte esterase test detects enzymes specific to polymorphonuclear leucocytes and can therefore be used as a sensitive indicator of pyuria. This study sought to evaluate its use as a rapid, sensitive, and non-subjective method of screening for NGU. Of the 81 men with urethral symptoms in the study group, 26 had more than 5 polymorphonuclear leucocytes per high power field (x 1000) and all 26 were leucocyte esterase test positive; whereas 55 had fewer than 5 polymorphonuclear leucocytes per high power field, but 29 (53%) of them had a positive leucocyte esterase test result. In addition, 25 patients in the study group yielded Chlamydia trachomatis on culture. Of these 25, 24 (96%) were leucocyte esterase test positive, whereas only 11 (44%) were Gram stain positive. All 40 patients in the control group (without urethral symptoms or signs) were leucocyte esterase test negative. The leucocyte esterase test is thus a rapid, sensitive, and non-subjective screening aid in the diagnosis of NGU.

Use of Kova-Slide II with grid and uncentrifuged segmented urine specimens in the diagnosis of nongonococcal urethritis: a quantitative technique.

An attempt was made to use uncentrifuged segmented urine specimens and Kova-Slide II with grid as a quantitative technique for the diagnosis of nongonococcal urethritis. Of the 100 men with urethral symptoms, 54 had fewer than five polymorphonuclear leukocytes per high-power field (x1000) in their gram-stained urethral smear. On the basis of examination of segmented urine and Kova-Slide test, 41 of these 54 patients were diagnosed as having nongonococcal urethritis. None of the 13 patients considered to be free of urethritis on the basis of segmented urine tests had a Chlamydia trachomatis--positive culture, and all became asymptomatic without treatment. All 46 patients who had more than five polymorphonuclear leukocytes per high-power field (x1000) also had positive segmented urine tests. The rate of isolation of C. trachomatis was similar for both groups of tests. This study revealed that patients with lower polymorphonuclear leukocyte counts in the first 10 ml of urine passed (voided-bladder urine 1) also had cultures positive for C. trachomatis. None of the 50 patients in the control group had polymorphonuclear leukocytes in either voided-bladder urine 1 or in the midstream specimen (voided-bladder urine 2). All controls had cultures negative for C. trachomatis.