Cross-sectional study of urethral exposures at last sexual episode associated with non-gonococcal urethritis among STD clinic patients

Chambers, Laura C; Morgan, Jennifer L.; Lowens, M Sylvan; Robinson, Tashina; Romano, Sarah S; Leipertz, Gina; Golden, Matthew R.; Khosropour, Christine M; Fredricks, David N.; Manhart, Lisa E.

doi:10.1136/sextrans-2018-053634

Cited by 11 publications

(10 citation statements)

References 18 publications

(6 reference statements)

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“…We identified 434 eligible men including 199 MSM (46%) and 235 MSW (54%), comprising 250 cases of NGU and 184 controls (Figure 1, Table 1, Supplementary Table 2). Detailed characteristics have been previously reported [15]. Among cases of NGU, 129 (52%) were infected with a single known pathogen, 3% had 2 pathogens detected, and less than 1% had 3 pathogens detected using NAAT or qPCR (Figure 1).…”

Section: Participant Characteristicsmentioning

confidence: 73%

“…Participants who were 16 years or older, assigned male sex at birth, attending the Public Health-Seattle & King County STD (sexually transmitted disease) Clinic, and previously recruited into a cross-sectional study between August 2014 and April 2018 [15] formed our case-control study population. The Institutional Review Boards at the University of Washington and Fred Hutchinson Cancer Research Center approved the study.…”

Section: Study Design and Study Populationmentioning

confidence: 99%

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Urethral Microbiota in Men: Association of Haemophilus influenzae and Mycoplasma penetrans With Nongonococcal Urethritis

Srinivasan

Chambers

Tapia

et al. 2020

Clinical Infectious Diseases

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Background Nongonococcal urethritis (NGU) is a common syndrome with no known etiology in up to 50% of cases. We estimated associations between urethral bacteria and NGU in men who have sex with men (MSM) and men who have sex with women (MSW). Methods Urine was collected from NGU cases (129 MSM; 121 MSW) and controls (70 MSM; 114 MSW) attending a Seattle STD clinic. Cases had ≥5 polymorphonuclear leukocytes on Gram stain plus symptoms or discharge; controls had <5 PMNs, no symptoms, no discharge. NGU was considered idiopathic when Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, Trichomonas vaginalis, adenovirus, and herpes simplex virus were absent. The urethral microbiota was characterized using 16S rRNA gene sequencing. Compositional lasso analysis was conducted to identify associations between bacterial taxa and NGU, and to select bacteria for targeted quantitative PCR (qPCR). Results Among NGU cases, 45.2% were idiopathic. Based on compositional lasso analysis, we selected Haemophilus influenzae (HI) and Mycoplasma penetrans (MP) for targeted qPCR. Compared to 182 men without NGU, the 249 men with NGU were more likely to have HI (14% vs. 2%) and MP (21% vs. 1%) (both p≤0.001). In stratified analyses, detection of HI was associated with NGU among MSM (12% vs. 3%, p=0.036) and MSW (17% vs. 1%, p<0.001), but MP was associated with NGU only among MSM (13% vs. 1%, p=0.004). Associations were stronger in men with idiopathic NGU. Conclusions HI and MP are potential causes of male urethritis. MP was more often detected among MSM than MSW with urethritis.

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Section: Participant Characteristicsmentioning

confidence: 73%

Section: Study Design and Study Populationmentioning

confidence: 99%

Urethral Microbiota in Men: Association of Haemophilus influenzae and Mycoplasma penetrans With Nongonococcal Urethritis

Srinivasan

Chambers

Tapia

et al. 2020

Clinical Infectious Diseases

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“…Associations between NGU and insertive anal and oral exposure have been reported ( 734 ), as have higher rates of BV-associated Leptotrichia or Sneathia species among heterosexual men with urethritis ( 735 ). These studies increase concern for possible undetected infectious rectal or vaginal pathogens, or alternatively, a transient reactive dysbiosis after exposure to a new microbiome or even a noninfectious reactive etiology ( 736 ).…”

Section: Diseases Characterized By Urethritis and Cervicitismentioning

confidence: 99%

Sexually Transmitted Infections Treatment Guidelines, 2021

Workowski¹,

Bachmann²,

Chan³

et al. 2021

MMWR Recomm. Rep.

1,594

2,621

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These guidelines for the treatment of persons who have or are at risk for sexually transmitted infections (STIs) were updated by CDC after consultation with professionals knowledgeable in the field of STIs who met in Atlanta, Georgia, June 11-14, 2019. The information in this report updates the 2015 guidelines. These guidelines discuss 1) updated recommendations for treatment of Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis; 2) addition of metronidazole to the recommended treatment regimen for pelvic inflammatory disease; 3) alternative treatment options for bacterial vaginosis; 4) management of Mycoplasma genitalium; 5) human papillomavirus vaccine recommendations and counseling messages; 6) expanded risk factors for syphilis testing among pregnant women; 7) one-time testing for hepatitis C infection; 8) evaluation of men who have sex with men after sexual assault; and 9) two-step testing for serologic diagnosis of genital herpes simplex virus. Physicians and other health care providers can use these guidelines to assist in prevention and treatment of STIs. BOX 1. The Five P's approach for health care providers obtaining sexual histories: partners, practices, protection from sexually transmitted infections, past history of sexually transmitted infections, and pregnancy intention Additional information about external condoms is available at https://www.cdc.gov/condomeffectiveness. Internal CondomsCondoms for internal vaginal use, also known as female condoms, are available worldwide (e.g., the FC2 Female Condom, Reddy condom, Cupid female condom, and Woman's condom) (31,32). Use of internal condoms can provide protection from acquisition and transmission of STIs, although data are limited. Internal condoms are more costly compared with external condoms; however, they offer the advantage of being controlled by the receptive partner as an STI and HIV prevention method, and the newer versions might be acceptable to all persons. Although the internal condom also has been used during receptive anal intercourse, efficacy associated with this practice remains unknown (33). Additional information about the internal condom is available at http://www.ashasexualhealth. org/pdfs/Male_and_Female_Condoms.pdf. Cervical DiaphragmsIn observational studies, diaphragm use has been demonstrated to protect against cervical gonorrhea, chlamydia, and trichomoniasis (34). However, a trial examining the effect of a diaphragm plus lubricant on HIV acquisition among women in Africa reported no additional protective effect when compared with the use of male condoms alone. Likewise, no difference by study arm in the rate of acquisition of chlamydia, gonorrhea, or herpes occurred (35,36). Diaphragms should not be relied on as the sole source of protection against HIV and other STIs.

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“…5 There is also speculation that non-CT/non-MG NGU may be due to inflammation caused by shifts in urethral microbial communities. 6 Urethral symptoms can also occur without objective signs of inflammation, 2 and some cases have been linked to chronic pelvic pain syndrome. 7,8 Nongonococcal urethritis leads to >200,000 male outpatient visits in the United States annually 9 ; however, this commonly cited estimate was derived from commercial data on physician prescribing practices in 2001.…”

Section: Methodsmentioning

confidence: 99%

Incidence of Nongonococcal Urethritis in Men Who Have Sex With Women and Associated Risk Factors

Rowlinson¹,

Chambers²,

Lowens

et al. 2020

Sexual Trans Dis

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Cross-sectional study of urethral exposures at last sexual episode associated with non-gonococcal urethritis among STD clinic patients

Cited by 11 publications

References 18 publications

Urethral Microbiota in Men: Association of Haemophilus influenzae and Mycoplasma penetrans With Nongonococcal Urethritis

Urethral Microbiota in Men: Association of Haemophilus influenzae and Mycoplasma penetrans With Nongonococcal Urethritis

Sexually Transmitted Infections Treatment Guidelines, 2021

Incidence of Nongonococcal Urethritis in Men Who Have Sex With Women and Associated Risk Factors

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