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Characteristics of Acute Nongonococcal Urethritis in Men Differ by Sexual Preference

Dysuria, defined as pain, burning, or discomfort on urination, is more common in women than in men. 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. SETTING–A public STD clinic in Sydney, Australia. In deze matrix kan alle relevante kennis over een aandoening worden geordend en de systematiek van diagnose en behandeling worden geëxpliciteerd. First-stream urine was tested for Chlamydia trachomatis and Mycoplasma genitalium by PCR. This initial illness may be characterized by fever, vomiting, diarrhea, muscle and joint pains, headache, sore throat, and/or painful lymph nodes. We ‘t know how large the seam was Saxon times, but it was equal to 8 bushels at least by the end of the thirteenth century.

• Ask about drug treatment. One is Zithromax – 4 tablets in one go. MSM with acute NGU were less likely to have C. Scabies is an ectoparasitic infection caused by a small bug that is not visible with the naked eye, but can be seen with a magnifying glass or microscope. Newer, rapid diagnostic tests that depend upon the identification of the genetic material of N. Even when C. trachomatis or M.

Syndromic management is an important component of the strategy advocated by the World Health Organization to control sexually transmitted diseases in developing countries and in settings where sophisticated diagnostic tests often are not available.1 Application of syndromic management requires the clinical identification of a defined clinical syndrome among symptomatic individuals, knowledge of the patterns of disease which comprise that syndrome, and the local antimicrobial susceptibilities of prevalent sexually transmitted disease bacterial pathogens. MSM with acute NGU are less likely to have the established bacterial sexually transmitted infections (STIs) and more likely to report protected anal sex or sexual activity other than anal sex prior to symptom onset than MSW. Abnormalities in urinary anatomy or function allow more unusual, recurrent, and persistent infections with organisms such as Proteus, Klebsiella, or Enterobacter species. Nucleic acid amplification techniques (NAAT) have allowed greater understanding of the variety of pathogens involved in acute nongonococcal urethritis (NGU) (1). This has included the recent recognition of Mycoplasma genitalium, herpes simplex virus (HSV), and adenoviruses as urethral pathogens (2,–5), although in a significant proportion of cases no urethral pathogen is currently identified. Bij mannen zonder écoulement moet bovendien materiaal binnenuit de urethra worden verkregen, waardoor het percentage fout-negatieve uitslagen kan stijgen tot 65.78 Giemsa- en Tzanck-preparaten (resp. Sporadic case reports implicate other bacteria such as Haemophilus species (Haemophilus influenzae and Haemophilus parainfluenzae), Streptococcus species (Streptococcus pneumoniae and Streptococcus pyogenes), and Moraxella catarrhalis in acute NGU, following orogenital sex (9,–11); however, their etiologic role has not been established in case-control studies.

Diagnostic and management approaches to acute NGU do not differentiate between men who have sex with men (MSM) and men who have sex with women (MSW). I am hoping I have self-diagnosed correctly but I have not had severe itching for weeks now. There might be an obvious urethral discharge but if not, milk the urethra to try and elicit one. When can we have unprotected sex again? Further elucidation of the etiology of this common syndrome, and developing an understanding of how sexual practices influence the detection of urethral pathogens, could improve the management of men and their partners (1, 12, 13). In this study, we examined behavioral, demographic, and laboratory characteristics of a large series of MSW and MSM with acute urethral symptoms over a 6-year period. We aimed to determine if there were key differences between MSW and MSM with acute NGU in the spectrum of pathogens involved and whether there were differences in sexual behavior preceding the acquisition of NGU.

We retrospectively reviewed the electronic case record database of Melbourne Sexual Health Centre, the main public sexually transmitted diseases clinic in Melbourne, Australia, from January 2006 to December 2011. Patients were required to have the diagnosis of acute NGU entered into the electronic medical record, with one or more of the following acute urethral symptoms for less than 1 month’s duration: urethral discharge and urethral irritation, discomfort, or itch; patients also needed to fulfill the conventional laboratory definition of urethritis, namely, 5 or more polymorphic neutrophilic lymphocytes/high-powered field (≥5 polymorphonuclear leukocytes [PMNL]/high-powered field [HPF]) on urethral Gram stain. One hundred and twenty (64.5%) of the men were infected with HIV. All subsequent presentations with acute NGU during the study period were excluded. In adult women, a history of external dysuria (pain as the urine passes over the inflamed vaginal labia) suggests vaginal infection or inflammation, whereas a history of internal dysuria (pain felt inside the body) suggests bacterial cystitis or urethritis.1 Pain at the onset of urination is usually caused by urethral inflammation, but suprapubic pain after voiding is more suggestive of bladder inflammation or infection. From June 2008, clients also completed a computer-assisted self-interview, recording detailed sexual behavior, a method that has been previously shown to be reliable and acceptable (14, 15). Responses were also routinely verified by the clinician at the time of the consultation.

Het onderscheidend vermogen van Gram- en MB-preparaat is ondermaats als er weinig of geen écoulement is en als men weinig ervaring heeft in het beoordelen ervan. trachomatis and M. genitalium testing by strand displacement amplification (ProbeTec-ETCT amplified DNA assay; Becton, Dickinson) and PCR as described by Yoshida et al. (16), respectively. These diagnostic assays are used to deliver results to patients and clinicians and have been accredited by the National Association of Testing Authorities (NATA), Australia. I had oral sex from a girl a few weeks ago. In this paper “bacterial pathogen” refers to cases where M.

genitalium or C. trachomatis was detected. “Idiopathic NGU” refers to cases where C. trachomatis and M. When HIV status is not considered, M genitalium was found no more frequently in men with any urethritis, gonococcal urethritis or NGU, than in men without urethritis. Consistent condom use for anal/vaginal sex refers to entry in the database of 100% condom use for anal and/or vaginal sex in the prior 3 months and frequently reflected the additional practice of unprotected oral sex, which could not be dually/additionally recorded in the database. Palpation and percussion of the abdomen provide information about kidney, ureter, or bladder inflammation.

This indicates no penetrative anal or vaginal sex occurred in the prior 3 months and reflects mainly the practice of oral sex, which is predominantly unprotected, but may also reflect other nonpenetrative sexual practices. Data were analyzed using SPSS version 20. Behandeling van herpes genitalis (met aciclovir) is alleen aangewezen als de aandoening ernstig en (of) uitgebreid is. Demographic, behavioral, and laboratory characteristics were compared in cases with and without pathogens. Cases were stratified by sexual preference and compared by univariate and multivariate logistic regression. Where two variables were strongly correlated, only the variable most strongly associated with the outcome was included. Finally, we conducted two subanalyses comparing behavioral characteristics of MSM to MSW restricted to idiopathic cases only and then to cases where M.


Answer: In very rare cases the 2 glass test can be helpful, ie. trachomatis was detected. Ethical approval for this study was granted by the Alfred Hospital Ethics Department (approval number 537/11). The need for written informed consent from participants was waived for this study, as all records were anonymized and deidentified with a false unit record number attached to the clinical record prior to analysis. During the study period, there were 5,452 presentations of males with acute urethral symptoms. Of these, 4,326 were first presentations with acute urethral symptoms, of which urethral Gram stains were performed in 3,053 (71%) cases. It is noteworthy that in another study11 acute symptomatic NGU was associated with these micro-organisms, whereas asymptomatic disease was not.

The study population was comprised of 1,295 (42%,) males who had both first presentation with acute urethral symptoms and fulfilled the laboratory criteria of greater than 5 PMNL/HPF on urethral Gram stain. Pyuria has a sensitivity of 96 percent.20,25 A dipstick test that is positive for nitrite suggests a probable UTI; however, a negative test does not rule out the diagnosis. A total of 380 (32%) cases reported ≥1 male partner in the prior 3 months (median of 3, IQR of 2 to 6), and 830 (70%) reported ≥1 female partner (median of 2, IQR of 1 to 3) (). Reported consistent condom use for anal sex (39%) was higher than for vaginal sex (14%; P < 0.001) in the 3 months prior to presentation. In de periode van behandeling moet men zich onthouden van vormen van seksueel contact waarbij micro-organismen kunnen worden overgedragen. trachomatis was detected in 401 (32%; 95% CI of 29 to 34%) and M. genitalium in 134 (11%; 95% CI of 9 to 13%) cases. There were no time trends in pathogen detection for either C. trachomatis or M. I don’t think I’ve got anything, but I’m worried. Overall, no pathogen was detected in 772 (59%) cases with acute NGU. The characteristics of cases with C. trachomatis and M. genitalium were similar to each other but differed from those associated with idiopathic NGU (). Compared to cases with idiopathic NGU, C. trachomatis- or M. genitalium-positive cases were less likely to have a recent male partner (P < 0.001) and were more likely to report a recent female partner (P < 0.001). Imaging studies and other diagnostic tests are indicated when the diagnosis is in doubt, when patients are severely ill or immunocompromised and do not respond to antibiotic therapy, and when complications are suspected (Table 44,21–24).23 Cystoscopy with or without a voiding urologic study, is an invasive test that can be used to rule out bladder or urethral pathology. trachomatis or M. genitalium to report recent engagement in low-risk practices, 100% condom use for vaginal/anal sex (P < 0.001), or sexual practices other than penetrative anal/vaginal sex as their only recent exposure (P = 0.002). The characteristics of bacterial NGU were compared to idiopathic NGU by multivariable analysis. Compared to cases with bacterial NGU, cases with idiopathic NGU were more likely to have consistently engaged in protected vaginal/anal sex (AOR = 1.8; 95% CI of 1.3 to 2.5), twice as likely to have had a male partner in the prior 3 months (AOR = 2.3; 95% CI of 1.7 to 3.1), and less likely to have a recent female partner (AOR = 0.4; 95% CI of 0.3 to 0.6). The characteristics of MSW exclusively reporting recent female partners were compared to MSM, exclusively reporting recent male partners (). Men reporting no sexual partners in the past 3 months (n = 13) and bisexual men (n = 35) were excluded. Due to the strong inverse correlation between the detection of bacterial pathogens and idiopathic NGU, two models were created to explore associations by multivariable analysis, the first model adjusting for idiopathic NGU and the second adjusting for the presence of C. trachomatis and M. genitalium. Compared to exclusive MSW, exclusive MSM with acute NGU were more than 8 times as likely to report sexual activity other than penetrative anal or vaginal sex (AOR = 8.0, 95% CI of 3.6 to 17.8 [model 1]; AOR = 9.1, 95% CI of 3.9 to 21.1 [model 2]) and 3 to 4 times as likely to report consistent condom use for penetrative anal/vaginal sex (AOR = 3.6, 95% CI of 2.7 to 5.0 [model 1]; AOR = 3.9, 95% CI of 2.7 to 5.4 [model 2]) in the prior 3 months. MSM were less likely to have either C. trachomatis (AOR = 0.4; 95% CI of 0.3 to 0.6) or M. genitalium (AOR = 0.5; 95% CI of 0.3 to 0.8) and more likely to have idiopathic NGU (AOR = 2.4; 95% CI of 1.8 to 3.3) than MSW. Interestingly, in a subanalysis of those infected with either C. trachomatis or M. genitalium, MSM were significantly more likely than MSW with these pathogens to report consistent protected anal/vaginal sex (OR = 4.7; 95% CI of 2.6 to 8.3). MSM with idiopathic NGU were also more likely than MSW to report protected sex (AOR = 3.5; 95% CI of 2.4 to 5.0) or sexual activity other than penetrative anal/vaginal sex as their only exposure (AOR = 5.8; 95% CI of 3.2 to 10.7) in the 3 months prior to symptom onset. In this large sample of males with symptomatic acute NGU, clear epidemiological and laboratory differences were observed between MSM and MSW. C. trachomatis and M. genitalium were detected significantly less frequently in MSM than in MSW. MSM were more likely than MSW to report relatively low-risk behaviors prior to symptom onset, such as consistent condom use for penetrative anal sex or sexual activity other than anal intercourse with recent partners, even when C. trachomatis or M. genitalium were detected. This study provides an important insight into the contribution and relevance of low-risk sexual behaviors to acute NGU, particularly in MSM, and has implications for etiologic research efforts and prevention and management approaches for acute NGU. While a retrospective study has limitations, it has allowed a much larger cohort to be investigated than would be possible prospectively. This is the largest published series of acute NGU, and the striking consistency with our more rigorous case-control study in pathogen detection and behavioral associations supports the validity of the findings, but with a cohort almost four times greater (2). The prevalence of pathogens identified in both studies is reassuringly similar, and these data confirm C. trachomatis and M. genitalium are less likely to be detected in MSM. The estimates for C. trachomatis and M. genitalium are also in keeping with other estimates from our service and region (17,–20). It was interesting to note that even in the presence of a bacterial pathogen, MSM reported more consistent condom use for anal sex than MSW for vaginal sex and that MSM with idiopathic NGU were also substantially more likely to report engaging in only nonpenetrative anal/vaginal sexual activity with their partners in the prior 3 months. Collectively, these data suggest that MSM may be acquiring established and unidentified urethral pathogens more commonly than anticipated via low-risk sexual practices, perhaps reflecting the widespread practice of unprotected orogenital sex in MSM and also other unmeasured nonpenetrative practices that could not be captured in our study. Others have reported that MSM are more likely to use condoms than MSW (21), and previous studies have shown insertive oral sex to be a predictive factor in MSM for nonchlamydial NGU (22, 23). Sporadic case reports of oral and respiratory bacteria, such as Corynebacterium diphtheria, M. catarrhalis, and Haemophilus and Streptococcus species in acute NGU, following orogenital sex support the contribution of oropharyngeal exposure to this syndrome and require examination in case-control studies using molecular methods (9,–11, 24, 25). The concept that the spectrum of pathogens may differ between MSM and MSW is further supported by the recent findings of Manhart et al., who examined whether key bacterial vaginosis-associated bacteria (BVAB) may be causal agents of acute NGU (26). In a case-control study involving predominantly MSW, Leptotrichia/Sneathia species were the only BVAB significantly associated with NGU and were detected in 15% of men with idiopathic NGU (26). Other BVAB (BVAB-2, BVAB-3, Megasphera) were most often identified in cases compared to in controls but were less common. Our group has previously reported that Gardnerella vaginalis, a common species within the vaginal microbiota and implicated in BV, was more common in controls than in NGU cases and associated with recent penile-vaginal sex (26); and as reported by Manhart et al., no association with Atopobium vaginae and NGU was found (unpublished data). These data support the broader premise that exchange of pathogenic and nonpathogenic species within the genital microbiota is occurring between sexual partners, with only some agents inducing disease or symptoms in a partner, which could also be influenced by host characteristics. Clearly, metagenomic studies will expand our etiologic understanding of idiopathic NGU, but these techniques generate vast data output, and epidemiologic studies provide important insights to refine the search into probable sources of NGU and the likely spectrum of agents.