Diagnosis and Etiology of Nongonococcal Urethritis

Swartz, Stephen L.; Kraus, Stephen J.; Herrmann, Kenneth L.; Stargel, M D; Brown, W. J.; Allen, Steven

doi:10.1093/infdis/138.4.445

Cited by 131 publications

(37 citation statements)

References 25 publications

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“…Cervicitis was defined as more PMNL than epithelial cells in wet smear. Urethritis is generally defined as .4 PMNL per high power field (HPF) in more than four HPF, 18 but in the current study smears with 5-10 PMNL per HPF were defined as ''grey zone urethritis'' and .10 PMNL per HPF as urethritis. 15 Endocervical specimens were obtained, using three sterile aluminium shafted Rayon swabs (Copan, Brescia, Italy).…”

Section: Patientsmentioning

confidence: 91%

“…29 At STD clinics microscopic examinations of methylene blue or Gram stained urethral and endocervical smears as well as examination of vaginal wet smears are routinely performed. The criteria for male urethritis were defined in 1978 18 but no definition of female urethritis or cervicitis has been established. When the cut of for microscopic urethritis was raised to .10 PMNL/HPF, as proposed by Stamm 30 fewer women in the screening group had this sign whereas all women infected with M genitalium having urethritis had .10 PMNL/HPF thus, the specificity of this sign increased.…”

mentioning

confidence: 99%

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Signs and symptoms of urethritis and cervicitis among women with or without Mycoplasma genitalium or Chlamydia trachomatis infection

Falk

Fredlund²,

Jensen³

2005

Sexually Transmitted Infections

183

158

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Objectives: To study the prevalence, symptoms, and signs of Mycoplasma genitalium and Chlamydia trachomatis infections in women attending a Swedish STD clinic, accessible for both sexes, and in a group of young women called in the cervical cancer screening programme. Methods: A cross sectional study among female STD clinic attendees in Ö rebro and a study among women called for Papanicolaou smear screening. Attendees were examined for urethritis and cervicitis. First void urine and endocervical samples were tested for M genitalium and C trachomatis. Results: The prevalence of C trachomatis and M genitalium in the STD clinic population was 10% (45/465) and 6% (26/461), respectively. Dual infection was diagnosed in four women. In the cancer screening group of women the corresponding prevalence was 2% (1/59) and 0%, respectively. Among the STD clinic attendees there were no significant differences in symptoms (32% v 23%, RR 1.4, 95% CI 0.6 to 3.4) or signs (71% v 50%, RR 1.4, 95% CI 0.9 to 2.3) between C trachomatis and M genitalium infections. Microscopic signs of cervicitis were significantly more common among M genitalium and C trachomatis infected women than in the cancer screening group of women. 56% (15/27) of male partners of M genitalium infected women were infected with M genitalium compared to 59% of male partners of C trachomatis infected women who were infected with C trachomatis (p = 0.80). Conclusions: M genitalium is a common infection associated with cervicitis and with a high prevalence of infected sexual partners supporting its role as a cause of sexually transmitted infection. M ycoplasma genitalium was isolated originally from the urethra of two men with non-gonococcal urethritis (NGU) in 1980.1 2 Isolation of this bacterium is very difficult, but the use of polymerase chain reaction (PCR) technology has consistently shown M genitalium to be a major cause of non-chlamydial non-gonococcal urethritis (NCNGU) among men. [2][3][4][5][6][7][8] There is also increasing evidence that M genitalium causes mucopurulent cervicitis in women 9 and that it may cause endometritis 10 11 and possibly tubal infection with sequelae in the form of ectopic pregnancy or tubal infertility.12 Only one published study has failed to show an association between urogenital tract disease and the presence of M genitalium in the female genital tract. 13 However, no asymptomatic patients were included in that study and surprisingly, as many as 38% of the women were positive compared with a C trachomatis prevalence of 8%, raising concern about the specificity of the M genitalium assay. Most M genitalium studies in STD clinic outpatients have focused on symptomatic patients with urethritis and have used nonsymptomatic patients as controls. These studies demonstrate that M genitalium, C trachomatis, and Neisseria gonorrhoeae are significantly more frequently detected among symptomatic patients than among asymptomatic controls, thus indicating that these bacteria are pathogens of the genital tract. This is emphasised by the fact t...

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Section: Patientsmentioning

confidence: 91%

mentioning

confidence: 99%

Signs and symptoms of urethritis and cervicitis among women with or without Mycoplasma genitalium or Chlamydia trachomatis infection

Falk

Fredlund²,

Jensen³

2005

Sexually Transmitted Infections

183

158

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“…For men without chlamydial infection, suggested etiologies of NGU include trichomoniasis, herpes simplex virus, and genital Mycoplasma/ureaplasmas, including M. genitalium. In the 1970s, several carefully conducted studies clearly demonstrated that C. trachomatis was the most common demonstrable pathogen, accounting for 30%-40% of cases of NGU [19][20][21] in men. However, in a more-recent, large, multicenter study [22], only 15% (range, 4%-35%; in 11 participating centers) of patients with NGU were found to be culture positive for C. trachomatis.…”

Section: Notementioning

confidence: 99%

High Rates ofTrichomonas vaginalisamong Men Attending a Sexually Transmitted Diseases Clinic: Implications for Screening and Urethritis Management

2003

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Trichomonas is a cause of nongonococcal urethritis (NGU); however, studies of its prevalence in men have been hampered by the lack of sensitive diagnostics. DNA amplification allows for reappraisal of the extent of infection in men. Men attending a sexually transmitted diseases clinic were tested for trichomonas, chlamydia, and gonorrhea. The prevalence of these pathogens was 17%, 19.6%, and 17.7% respectively. In men with NGU, 19.9% were infected with trichomonas. These data have implications for treatment of NGU and control of trichomoniasis.

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“…A Gram-stained urethral smear containing 55 PMNL per high-power (61000) microscopic ® eld (averaged over ® ve ® elds with greatest concentration of PMNLs) 9 , and/or . The identi® cation of 510 PMNL per highpower (61000) microscopic ® eld (averaged over ® ve ® elds with greatest concentration of PMNLs) on a Gram-stained preparation from a FPU specimen.…”

Section: Microscopy Availablementioning

confidence: 99%

European guideline for the management of urethritis

2001

Int J STD AIDS

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Diagnosis and Etiology of Nongonococcal Urethritis

Cited by 131 publications

References 25 publications

Signs and symptoms of urethritis and cervicitis among women with or without Mycoplasma genitalium or Chlamydia trachomatis infection

Signs and symptoms of urethritis and cervicitis among women with or without Mycoplasma genitalium or Chlamydia trachomatis infection

High Rates ofTrichomonas vaginalisamong Men Attending a Sexually Transmitted Diseases Clinic: Implications for Screening and Urethritis Management

European guideline for the management of urethritis

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