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Data from a large prospective multicenter clinical validation study of a nucleic acid amplification in vitro diagnostic test for Mycoplasma genitalium were analyzed to describe the prevalence of M. genitalium infection, risk factors, and disease associations in female and male patients seeking care in diverse geographic regions of the United States. Among 1,737 female and 1,563 male participants, the overall prevalence of M. genitalium infection was 10.3% and was significantly higher in persons ages 15 to 24 years than in persons ages 35 to 39 years (for females, 19.8% versus 4.7% [odds ratio {OR} = 5.05; 95% confidence interval {CI} = 3.01 to 8.46]; for males, 16.5% versus 9.4% [OR = 1.91; 95% CI = 1.20 to 3.02]). The risk for M. genitalium infection was higher in black than in white participants (for females, 12.0% versus 6.8% [OR = 1.88; 95% CI = 1.30 to 2.72]; for males, 12.9% versus 6.9% [OR = 2.02; 95% CI = 1.38 to 2.96]) and higher in non-Hispanic than in Hispanic participants (for females, 11.2% versus 6.0% [OR = 1.97; 95% CI = 1.25 to 3.10]; for males, 11.6% versus 6.8% [OR = 1.80; 95% CI = 1.14 to 2.85]). Participants reporting urogenital symptoms had a significantly elevated risk of M. genitalium infection compared to that for asymptomatic individuals (for females, OR = 1.53 [95% CI = 1.09 to 2.14]; for males, OR = 1.42 [95% CI = 1.02 to 1.99]). Women diagnosed with vaginitis and cervicitis had a higher prevalence of M. genitalium infection than women without those diagnoses, although this was statistically significant only for vaginitis (for vaginitis, OR = 1.88 [95% CI = 1.37 to 2.58]; for cervicitis, OR = 1.42 [95% CI = 0.61 to 2.96]). A diagnosis of urethritis in men was also significantly associated with M. genitalium infection (OR = 2.97; 95% CI = 2.14 to 4.13). Few characteristics distinguished asymptomatic from symptomatic M. genitalium infections. These results from persons seeking care in the United States suggest that M. genitalium infection should be considered in young persons presenting with urogenital symptoms., (Copyright © 2020 Manhart et al.)

Since 2015 in the United States (US), the US Neisseria meningitidis urethritis clade (US_NmUC) has caused a large multistate outbreak of urethritis among heterosexual males. Its 'parent' strain caused numerous outbreaks of invasive meningococcal disease among men who have sex with men in Europe and North America. We highlight the arrival and dissemination of US_NmUC in the United Kingdom and the emergence of multiple antibiotic resistance. Surveillance systems should be developed that include anogenital meningococci.

Urethritis, or inflammation of the urethra, is one of the most common reasons men seek clinical care. Sexually transmitted pathogens including Neisseria gonorrhoeae are responsible for over half of the symptomatic urethritis cases in U.S. men. Recently, clinics in Indianapolis, Columbus, Atlanta, and other U.S. cities began to note increasing numbers of men presenting with urethritis and Gram-negative intracellular diplococci in their urethral smears who test negative for N. gonorrhoeae. Many of these discordant cases, which have periodically reached highs of more than 25% of presumed gonococcal cases in some sexually transmitted infection clinics in the U.S. Midwest, are infected with strains in a novel urethrotropic clade of Neisseria meningitidis ST-11 (US_NmUC). However, no cultivation-independent tests are available for the US_NmUC strains, and prior studies relied on microbial culture and genome sequencing to identify them. Here, we describe a PCR test that can identify the US_NmUC strains and distinguish them from commensal and invasive N. meningitidis strains as well as N. gonorrhoeae. Our SimpleProbe®-based real-time PCR assay targets a conserved nucleotide substitution in a horizontally acquired region of US_NmUC strain genomes. We applied the assay to 241 urine specimens whose microbial compositions had previously been determined by deep shotgun metagenomic sequencing. The assay detected the single US_NmUC positive case in this cohort, with no false positives. Overall, our simple and readily adaptable assay could facilitate investigation of the pathogenesis and epidemiology of the US_NmUC clade., Competing Interests: The authors have declared that no competing interests exist.

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.)

A previous MSMR report found that 42.8% of all incident (first-time) urinary tract infections (UTIs) in males, but only 0.4% of such UTIs in females, were diagnosed as "urethritis, unspecified" (ICD-9: 597.80). This study explored the possibility that many of the diagnoses of urethritis in males represented sexually transmitted infections (STIs), even though ICD-9: 597.80 is explicitly reserved for cases of urethritis that are deemed to not be sexually transmitted. Examined were relationships between diagnoses of urethritis, diagnoses of STIs, and recurrent diagnoses of UTIs. Male service members who received a diagnosis of "urethritis, unspecified" (ICD-9: 597.80) had an increased risk of a subsequent UTI diagnosis, especially of "urethritis, unspecified," compared to all male service members. Most service members who were diagnosed with "urethritis, unspecified" had no documented diagnoses of an STI in their Military Health System health records; however, recurrent UTIs were more common among service members who did have documented STIs. The most commonly diagnosed STIs in this study were "other non-gonococcal urethritis" (which includes that caused by Chlamydia trachomatis) and gonorrhea.

Objectives: We aimed to create a system for predicting which male emergency department (ED) patients with suspected chlamydial and/or gonococcal urethritis would have laboratory-confirmed infections based on clinical factors available at the initial ED encounter., Methods: We used statistical models to develop a system to predict either the presence or absence of laboratory-confirmed chlamydial and/or gonorrheal urethritis based on patient demographics and presenting symptoms. Data for the system were extracted from a retrospective chart review of adult male patients who were suspected of having, and were tested for, chlamydial and/or gonococcal urethritis at an adult, urban, northeastern United States, academic ED from January 1998 to December 2004., Results: Among the 822 patients tested, 29.2% had chlamydia, gonorrhea, or both infections; 13.8% were infected with chlamydia alone, 12.1% were infected with gonorrhea alone, and 3.3% were infected with both. From the statistical models, the following factors were predictive of a positive laboratory test for chlamydia and/or gonorrhea: age < or = 24 years, penile discharge, sexual contact with someone known to have chlamydia and/or gonorrhea, and not having health care insurance. A system using a hierarchical grouping of these factors based on the predicted probabilities of a laboratory-confirmed chlamydial and/or gonococcal urethritis, paired with baseline ED prevalence of these infections, was confirmed through internal validation testing to modestly predict which patients had or did not have a laboratory-confirmed infection., Conclusions: This system of a combination of risk factors available during the clinical encounter in the ED modestly predicts which adult male patients suspected of having chlamydial and/or gonorrheal urethritis are more likely to have or not have a laboratory-confirmed infection. A prospective study is needed to create and validate a clinical prediction rule based on the results of this system.

This study evaluated the adequacy of testing, empiric treatment and referral for further evaluation of adult male emergency department (ED) patients with possible chlamydia and/or gonorrhoea urethritis. Of 968 adult male ED patients, 84% were tested for chlamydia and gonorrhoea, 16% for HIV and 27% for syphilis; 92% received empiric treatment for chlamydia and gonorrhoea and 71% were referred for further evaluation; of those tested, 29% were infected with chlamydia, gonorrhoea or both; and 3% of those tested had a positive syphilis test. The results of logistic regression modelling indicated that testing, treatment and referral were not related to a history of sexual contact with someone known to have a sexually transmitted disease or to the patient's ultimate diagnosis of a laboratory-confirmed infection. Compliance with Centers for Disease Control and Prevention (CDC) recommendations for chlamydia and gonorrhoea testing and treatment regimens was high, but was poor for HIV testing. More explicit guidance from CDC regarding syphilis testing and referral for further evaluation is needed.

Unlabelled: Little is known about gaps in quality and the extent to which clinical standards are used in emergency department (ED) practice., Objectives: To determine whether ED practitioners comply with the Centers for Disease Control and Prevention (CDC) recommendations for diagnosing and treating sexually transmitted diseases (STDs)., Methods: A retrospective chart review of ED visits was conducted at an urban teaching hospital. Using ICD-9 codes, urethritis, cervicitis, pelvic inflammatory disease (PID), gonorrhea, and chlamydia cases seen from May 1, 2000, to February 28, 2001, were identified. Documentation of components of the history, physical examination, diagnostic testing, prescribed antibiotics, and discharge instructions necessary to comply with the CDC guidelines were abstracted. This set of comprehensive criteria was compared with a less stringent subset of selected criteria., Results: Two hundred forty-six patient visits were identified, and 203 (83%) were included. Forty-eight men and 155 women were included: 48 (24%) with urethritis, 34 (17%) with cervicitis, and 121 (60%) with PID. For urethritis, cervicitis, and PID, respectively, there was documentation of compliance with indicators related to the following: history 73%, 15%, and 14%; physical examinations 63%, 15%, and 22%; diagnostic testing 79%, 71%, and 71%; antibiotic use 33%, 32%, and 32%; and safe sex instructions 50%, 18%, and 15% of the time. Men were more likely to receive safe sex instructions (p < or = 0.01). Total (100%) compliance in all five domains occurred 8% of the time for urethritis, 3% for cervicitis, and never for PID. The rates of 100% compliance were not significantly different when a subset of selected criteria was used., Conclusions: Deficits in adherence to recommended guidelines for the diagnosis and treatment of STDs exist in ED practice.

Purpose: To describe current knowledge about diagnosis, screening, and treatment of sexually transmitted urethritis among adolescent and young adult males., Data Sources: Current research, systematic reviews, consensus guidelines and the author's clinical experience., Conclusions: Urethritis, the most common sexually transmitted syndrome in young males, is most frequently caused by Chlamydia trachomatis and/or Neisseria gonorrhea. Symptoms include dysuria and penile discharge, although up to 50% of males are asymptomatic. Risky sexual behaviors and lack of access to healthcare increase incidence of this infection. Transmission to female partners can lead to pelvic inflammatory disease, infertility, and neonatal infection., Implications for Practice: Young males with urethritis must be treated as soon as diagnosis is established. Consensus guidelines exist for diagnosis and treatment of gonococcal and non-gonococcal urethritis. Careful patient education is necessary to ensure successful treatment. Prevention of repeat infections requires partner treatment and detailed education about safer sexual practices. Improved access to preventive services for young males should be a healthcare priority.

The diagnosis and treatment of STDs is a common problem in primary care practice; however, newer diagnostic and therapeutic alternatives require physicians to be aware of evidence-based guidelines that are continuing to evolve. The treatment of STDs in men, in particular, is an area of evolving evidence because much of what is known is based on the treatment of STDs in women. Men represent unique challenges in diagnosis, evaluation, and follow-up that need to be considered in the treatment of urethritis, epididymitis, herpes genitalis, condyloma, prostatitis, and other syndromes. Screening for asymptomatic STDs is currently not recommended in the general population, but selected criteria can be used to identify a target population for screening in high-risk areas.

It is likely that up to 50% of the U.S. population will acquire a sexually transmitted disease by age 30 to 35. In industrialized countries, herpes simplex virus is by far the most common pathogen. The major public health impact of HSV infection is its brutal legacy to newborns. Half of the affected infants die at birth, and many of the survivors have severe neurodevelopmental disabilities.

The "traditional" venereal diseases account for a small fraction of the sexually transmitted diseases prevalent in industrialized societies. The clinical as well as the public health impact of the widening range of STDs is discussed.

Male university students were studied to evaluate the merit of routine screening for chlamydia urethritis. Two hundred fourteen sexually active male students answered a questionnaire about symptoms of urethritis and exposure to and treatment for sexually transmitted diseases (STDs). All subjects were screened for chlamydia by enzyme immunoassay (Chlamydiazyme, Abbott Laboratories). Overall, Chlamydiazyme was positive in 42 of 214 subjects (19.6%). Eighty-six subjects had no symptoms and no history of untreated exposure to STD; 6 of these had positive Chlamydiazyme assays. Based on our results, we conclude that the proportion of male urethral chlamydia infections that are asymptomatic may be much higher than has previously been believed. We further conclude that asymptomatic sexually active male students on this campus are a high-risk population for whom routine chlamydia screening is appropriate.

Nongonococcal urethritis (NGU) and its counterparts in women are the most common sexually transmitted disease syndromes in the United States and Western Europe. Chlamydia trachomatis causes 40 to 50 percent of the cases of NGU and is a major cause of mucopurulent cervicitis and urethral infection in women, epididymitis in young men, pelvic inflammatory disease, acute perihepatitis, and neonatal conjunctivitis and pneumonia. Chlamydial infection also has been linked with Reiter's syndrome, infertility, cervical dysplasia, stillbirth, postpartum endometritis, and other syndromes. Tetracycline HCl is the treatment of choice for NGU and related syndromes, and for the sexual partners of infected patients.

This review presents the epidemiologic, diagnostic, and office management of the gonorrhea patient. Better techniques in obtaining specimens from various sites are reviewed. For example, an effective method for obtaining specimens without the use of an anoscope and the utility of the Gram stain in the laboratory diagnosis of gonorrhea are described. Complications, diagnosis and predisposing factors of disseminated gonococcal infections are also discussed. Follow-up management of patients with gonorrhea with emphasis placed on test-of-cure cultures and testing for penicillinase producing Neisseria gonorrhoeae (PPNG) strains in all treatment failure cases is also presented. The cooperation between public and private health professionals and screening programs have lessened the gonorrhea reservoir in the United States. Therefore, early treatment through targeted screening, and epidemiologic treatment to sexual partners are important guidelines in gonorrhea control.