Characteristics of Acute Nongonococcal Urethritis in Men Differ by Sexual Preference

Abstract

N ucleic 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. The role of Ureaplasma urealyticum in NGU has been somewhat controversial, but recent evidence implicates specific biovars and possibly higher bacterial loads as causally associated with acute NGU (6-8). 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). Yet sexual behaviors differ considerably between these groups, and it is therefore likely that the spectrum of pathogens varies. In support of this, a previous case-control study of NGU in our service found that Chlamydia trachomatis or M. genitalium were more likely to be associated with female partners, while viruses, such as HSV and adenovirus, were associated with a recent history of male sexual partners (2). 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. MATERIALS AND METHODSStudy population. 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 (Ն5 polymorphonuclear leukocytes [PMNL]/high-powered field [HPF]) on urethral Gram stain. Importantly, only a single first episode of acute NGU per case over the study period was included. All subsequent

Management of non-gonococcal urethritis

“…Mycoplasma genitalium has emerged as the second most common aetiological agent, causing 10–30 % of cases [ 5 – 7 ], with a double infection with C. trachomatis in 5 to 15 % [ 8 ]. In 30–60 % of the cases with NGU neither C. trachomatis nor M. genitalium is detected [ 9 , 10 ]. Pathogen negative NGU is more likely with increasing age, the absence of discharge or clinical symptoms, and engagement in low-risk practices [ 9 – 11 ].…”

Sterile Pyuria

“…C. trachomatis was detected in 401 men (31%), and Mycoplasma genitalium was diagnosed in 134 men (10%). 12 A Japanese study involving 51 men showed that the 16S ribosomal RNA gene of Ureaplasma urealyticum (quantified by means of a real-time polymerase-chain-reaction [PCR] assay) was associated with the presence of symptoms of urethritis and higher leukocyte counts in first voided urine. 13 …”

Scrotal Swellings Synopsis of Differential Diagnosis (Part III)

“…Epididymo-orchitis [14,15,32,33] Acute gonococcal [34] / non-gonococcal urethritis (NGU) [35][36][37][38][39][40] / non specific urethritis (NSU), Chronic…”