Search

We found that the odds of return clinic visits for persistent non-gonococcal urethritis (NGU) were significantly lower (odds ratio: .4; 95% confidence interval: .3-.6; P < .0001) after implementing (1) testing for Mycoplasma genitalium during initial evaluations for NGU and (2) switching from azithromycin to doxycycline as first-line NGU treatment., Competing Interests: Potential conflicts of interest. S. E. C. was a co-investigator for the DoxyPEP study, which received material support (donated medication and STI testing supplies) from Mayne Pharmaceuticals, Hologic, and Cepheid. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

We documented urethral Treponema pallidum infection in a man with nongonococcal urethritis and a negative syphilis serology using broad-range bacterial polymerase chain reaction (PCR) and sequencing, targeted PCR, and immunofluorescence microscopy. He subsequently seroconverted for syphilis. Early syphilis may present as urethritis. Urethral T. pallidum shedding can occur before seroconversion., (© The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)

Neisseria gonorrhoeae and Chlamydia trachomatis are well-documented urethral pathogens, and the literature supporting Mycoplasma genitalium as an etiology of urethritis is growing. Trichomonas vaginalis and viral pathogens (herpes simplex virus types 1 and 2 and adenovirus) can cause urethritis, particularly in specific subpopulations. New data are emerging regarding the potential role of bacterial vaginosis-associated bacteria in urethritis, although results are inconsistent regarding the pathogenic role of Ureaplasma urealyticum in men. Mycoplasma hominis and Ureaplasma parvum do not appear to be pathogens. Men with suspected urethritis should undergo evaluation to confirm urethral inflammation and etiologic cause. Although nucleic acid amplification testing would detect N. gonorrhoeae and C. trachomatis (or T. vaginalis if utilized), there is no US Food and Drug Administration-approved clinical test for M. genitalium available in the United States at this time. The varied etiologies of urethritis and lack of diagnostic options for some organisms present treatment challenges in the clinical setting., (© The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.)

In April 2013, the Centers for Disease Control and Prevention (CDC) convened an advisory group to assist in development of the 2015 CDC sexually transmitted diseases (STDs) treatment guidelines. The advisory group examined recent abstracts and published literature addressing the diagnosis and management of sexually transmitted infections. This article summarizes the key questions, evidence, and recommendations for the diagnosis and management of epididymitis that were considered in preparation of the 2015 CDC STD treatment guidelines., (© The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.)

Objectives: We treated gonococcal urethritis in men with a single 2 g dose of azithromycin extended-release formulation (azithromycin-SR) to determine its microbiological outcomes and tolerability., Patients and Methods: We enrolled 189 Japanese men with gonococcal urethritis between April 2009 and December 2013. The patients were given a single 2 g dose of azithromycin-SR. Microbiological efficacy was evaluated by the results of the post-treatment molecular testing of Neisseria gonorrhoeae. MIC testing was performed only for pretreatment isolates of N. gonorrhoeae collected from the patients., Results: We evaluated 130 patients for microbiological outcomes. Of these patients, 122 (93.8%) were judged to be microbiologically cured on the basis of negative test results. All isolates for which the azithromycin MICs were ≤0.25 mg/L were eradicated, whereas 5 of 12 isolates for which the MICs were 1 mg/L persisted after the treatment. Forty-six adverse events occurred in 41 patients. However, all adverse events were classified as mild., Conclusions: The eradication rate of N. gonorrhoeae was 93.8% in men with gonococcal urethritis treated with a single 2 g dose of azithromycin-SR. The breakpoint MIC of a 2 g dose of azithromycin-SR for gonococcal urethritis associated with clinical treatment failures appeared to be 1 mg/L. With regard to side effects of higher doses of azithromycin, the 2 g dose of azithromycin-SR appeared to improve tolerability. However, the widespread use of a high-dose regimen of azithromycin might lead to the development of further resistance to azithromycin., (© The Author 2014. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.)

Background: Many countries have witnessed a disturbing increase in cases of Chlamydia trachomatis infection despite enhanced control programs. Since the goal of Chlamydia control is to prevent reproductive complications such as pelvic inflammatory disease and ectopic pregnancy, an understanding of recent trends in these conditions is needed to fully evaluate the effect of control efforts., Methods: We analyzed 2 provincial, comprehensive health services administrative databases (encompassing hospitalizations and all physician-delivered services) for pelvic inflammatory disease and ectopic pregnancy trends from 1992 through 2009 in women of reproductive age in British Columbia, Canada. Trends were compared to provincial Chlamydia surveillance data by time-series analysis, using the cross-correlation function method and Granger causality testing., Results: Chlamydia cases substantially increased from 1992 through 2009. Inpatient, outpatient, and total diagnoses of pelvic inflammatory disease and ectopic pregnancy declined from 1992 through 2003. After 2003, pelvic inflammatory disease rates continued to fall, while ectopic pregnancy rates significantly increased. The male Chlamydia urethritis rate increased from 39.4 to 173.6 cases/100,000 from 1996 to 2009., Conclusions: In the context of increasing Chlamydia infection rates, the reproductive complications of Chlamydia infection in women are declining overall. A recent increase in rates of ectopic pregnancies is cause for concern.

Mycoplasma genitalium is associated with acute and chronic urethritis in men. Existing data on infection in women are limited and inconsistent but suggest that M. genitalium is associated with urethritis, cervicitis, pelvic inflammatory disease, and possibly female infertility. Data are inconclusive regarding the role of M. genitalium in adverse pregnancy outcomes and ectopic pregnancy. Available data suggest that azithromycin is superior to doxycycline in treating M. genitalium infection. However, azithromycin-resistant infections have been reported in 3 continents, and the proportion of azithromycin-resistant M. genitalium infection is unknown. Moxifloxacin is the only drug that currently seems to uniformly eradicate M. genitalium. Detection of M. genitalium is hampered by the absence of a commercially available diagnostic test. Persons with persistent pelvic inflammatory disease or clinically significant persistent urethritis or cervicitis should be tested for M. genitalium, if possible. Infected persons who have not previously received azithromycin should receive that drug. Persons in whom azithromycin therapy fails should be treated with moxifloxicin.

Background: Urinary tract infections are the most common infections seen in hospitalized patients and the second most common, after respiratory tract infections, seen in the general population. The World Wide Web can now assist healthcare professionals in finding up-to-date information on different medical conditions., Methods: We sought to identify websites that contain information on urogenital infections by using popular search engines, such as Google and Yahoo. We also reviewed the sites of major institutions, and international healthcare associations. Only those sites that were written in English, were open access, and developed by a government, academic institution or a national or international healthcare professionals association were included., Results: We selected 114 sites that provide healthcare professionals with useful information on urogenital infections based on the criteria described above., Conclusions: There are several free websites that contain worthy information on urogenital infections. The compilation of a list of Internet resources on these common types of infections may be useful to practitioners and medical students.

The prevalence of various microorganisms known to cause nongonococcal urethritis, including herpes simplex virus (HSV), was evaluated. The findings suggest that HSV can be a significant etiological agent in nongonococcal urethritis (NGU) and that the necessary laboratory investigations should be performed for all patients with clinical symptoms of NGU.

Urethritis in men has been categorized historically as gonococcal or nongonococcal (NGU). The major pathogens causing NGU are Chlamydia trachomatis and Ureaplasma urealyticum. Trichomonas vaginalis may be involved occasionally. In up to one-half of cases, an etiologic organism may not be identified. In this review we present recent advances in the diagnosis and management of NGU and discuss how they may be applied in a variety of clinical settings, including specialized STD clinics and primary health care practices. In particular, the development of the noninvasive urine-based nucleic acid amplification tests may warrant rethinking of the traditional classification of urethritis as gonococcal urethritis or NGU. Diagnostic for Chlamydia are strongly recommended because etiologic diagnosis of chlamydial urethritis may have important public health implications, such as the need for partner referral and reporting. A single 1-g dose of azithromycin was found to be therapeutically equivalent to the tetracyclines and may offer the advantage of better compliance.

In an attempt to further define the natural history of Mycoplasma genitalium and Mycoplasma fermentans infections in humans, we used cultures and the polymerase chain reaction (PCR) to determine whether these organisms were present in the urethra and cervix of sexually active adults and in the amniotic fluid of women whose membranes were intact and collected at the time of cesarean delivery (to preclude cervical contamination). M. genitalium was detected by PCR but not by culture in 11% of patients with urethritis or cervicitis. It was not detected by either PCR or culture in the 232 amniotic fluid samples analyzed. In contrast, M. fermentans was not detected by either method in patients with urethritis or cervicitis but was detected by PCR in 4 of 232 amniotic fluid samples tested. These results indicate that in these four cases M. fermentans was transferred transplacentally. Histological evidence of chorioamnionitis was present in two of the four patients, a finding suggesting that M. fermentans may be a cause of chorioamnionitis. These results must be confirmed by other investigators, and further studies should be undertaken to determine the potential clinical significance of M. fermentans infection.

Control of Trichomonas vaginalis is assuming higher priority because recent studies have suggested that trichomoniasis enhances susceptibility to human immunodeficiency virus infection and the risk for delivery of low-birth weight infants. In a cross-sectional study, 50 cases were identified among 447 men attending a sexually transmitted disease clinic. As previously reported, trichomoniasis was associated with nonchlamydial nongonococcal urethritis. Other risk factors included sexual contact with an infected woman or prior treatment for trichomoniasis or nongonococcal urethritis. Urethral and first-void urine cultures were positive in 80% and 68% of positive cases, respectively. When combined, these two cultures diagnosed 49 (98%) of 50 cases. These data suggest that criteria for selection of men for culture should include presence of nonchlamydial nongonococcal urethritis, recent exposure to trichomoniasis, or a history of trichomoniasis or nongonococcal urethritis. In addition, combining urethral and urine sediment cultures may prove accurate for evaluating T. vaginalis infection.

The annual incidence of urethritis can be estimated to be at lest 3750 per 100,000 population in Swaziland. In a study of 109 males with symptomatic urethritis 80% had gonorrhoea, 6% non-gonococcal urethritis (ngu) and 14% were classified as having no 'objective' urethritis (less than 5 polymorphonuclear leucocytes per highpower field in the urethral smear). The relative frequency of gonorrhoea was 80 to 95% and of non-gonococcal urethritis 5 to 20 according to which criteria are used for patient selection and/or diagnosis of ngu. Chlamydia trachomatis was cultured in 3.4% of the cases with urethritis, comprising one positive culture in 70 patients with gonorrhoea, one in 5 with ngu, and one in 12 with no 'objective' urethritis. Seventy-one percent of patients, with a comparable percentage in each diagnostic group, had chlamydial antibodies when tested by the micro immunofluorescence test to pooled chlamydial antigens. Interpretation of the chlamydial serologic results indicates that lymphogranuloma venereum is probably endemic in the country, and that oculogenital chlamydial infections are not a problem; this corresponds with the low isolation rate of Chlamydia trachomatis in the urethritis cases. The study shows that the epidemiology and causes of urethritis are clearly of a different pattern to that seen in industrialised countries. This type of study is a sound basis for a simplified but effective urethritis control programme which can be implemented in the para-urban and rural health centres in developing countries.

The results of a study of the antibodies that react with Neisseria gonorrhoeae in the urethral exudates of 232 men who attended a clinic of the Department of Sexually Transmitted Diseases at Glasgow, Scotland, are presented. Of 132 men with gonorrhea, antibodies to the gonococcus were identified by use of an indirect immunofluorescent antibody test in 129 (98%): IgA antibody was found in all 129 (98%), IgG antibody in 119 (90%), and IgM antibody in 64 (49%). IgA antibody to the gonococcus was found in the secretions of only one (1%) of another 100 patients who did not have gonococcal urethritis (50 had nongonococcal urethritis and 50 had no evidence of urethritis). IgG antibody was found in 13 (26%) of the 50 men with nongonococcal urethritis and in none of the 50 men who had no evidence of urethritis. When treatment of gonorrhea was successful, the titers of IgA and IgM antibody declined rapidly and were generally undetectable within 14 days; the titers of IgG declined more slowly and could still be detected 28 days after treatment.

The observation of more than four polymorphonuclear cells (PMN) per high-power field (hpf) in gram-stained smears of urethral secretions was found to differentiate patients with urethritis from patients without urethritis. A urethral discharge was present in 78% of patients with nongonococcal urethritis (NGU). Dysuria without demonstrable urethral discharge and with fewer than four PMN/hpf did not appear to fit into the NGU spectrum. NGU is now defined to include men who have negative urethral cultures for Neisseria gonorrhoeae with a urethral discharge and/or more than four PMN/hpf in their urethral smears. The findings of more than four PMN/hpf in the urethral smears of 22%of asymptomatic sexually active men with more than one sexual partner (polygamous controls) suggests that asymptomatic NGU is not uncommon. Chlamydia trachomatis was isolated significantly more frequently from the NGU study group than from the control group (P less than 0.001). This study adds Corynebacterium vaginale (Haemophilus vaginalis), group B streptococci, and yeasts to the list of sexually transmitted microorganisms that are not etiologic determinants of NGU.

Of 377 men attending clinics for the treatment of sexually transmitted disease, 104 had gonococcal urethritis, 72 had definite nongonococcal urethritis, 53 had possible nongonococcal urethritis, and 123 had no urethritis. A purulent urethral discharge was noted in 78% and 14% of patients with gonococcal urethritis and definite nongonococcal urethritis, respectively (P less than 0.001). In contrast, 4% and 64% of men with gonococcal urethritis and definite nongonococcal urethritis, respectively, had a clear urethral discharge (P less than 0.001). Black men with urethritis were more likely to have gonococcal infection, whereas white men were more likely to have nongonococcal urethritis. Homosexual and bisexual white men with urethritis were more likely to have gonorrhea, whereas heterosexual white men with urethritis were more likely to have nongonococcal urethritis. Heterosexual men were more likely than homosexual men to be colonized with Ureaplasma urealyticum. There were no differences in the rates of colonization with Mycoplasma hominis among heterosexual and homosexual men.

Chlamydia trachomatis was isolated from 47% of asymptomatic, sexually active men whose urethral smears contained four or more polymorphonuclear leukocytes (PMN) per high-power field (hpf) one week after their sexual activity was restricted. C. trachomatis was not detected in any of 23 asymptomatic, sexually active men having less than 4 PMN/hpf in two urethral smears obtained one week apart. Semiquantitation of urethral PMN in the urethral Gram-stained smear is useful in the evaluation of asymptomatic men without gonorrhea who are concerned about the possibility of harboring a urethral pathogen.