Male non‐gonococcal urethritis: From microbiological etiologies to demographic and clinical features

Abstract

Objectives: To detect microorganisms responsible for male acute urethritis and to define the microbiology of non-gonococcal urethritis. Methods: The present study comprised 424 men with symptoms and signs compatible with acute urethritis. Their urethral swabs and first-voided urine underwent detection of the microorganisms. Demographic characteristics and clinical features of Mycoplasma genitalium-, Ureaplasma urealyticum-, Haemophilus influenza-, adenovirusor Herpes simplex virus-positive monomicrobial non-gonococcal urethritis, or allexamined microorganism-negative urethritis in heterosexual men were compared with urethritis positive only for Chlamydia trachomatis. Results: Neisseria gonorrhoeae was detected in 127 men (30.0%). In 297 men with non-gonococcal urethritis, C. trachomatis was detected in 143 (48.1%). In 154 men with non-chlamydial non-gonococcal urethritis, M. genitalium (22.7%), M. hominis (5.8%), Ureaplasma parvum (9.1%), U. urealyticum (19.5%), H. influenzae (14.3%), Neisseria meningitidis (3.9%), Trichomonas vaginalis (1.3%), human adenovirus (16.2%), and Herpes simplex virus types 1 (7.1%) and 2 (2.6%) were detected. Although some features of monomicrobial non-chlamydial non-gonococcal urethritis or all-examined microorganismnegative urethritis were significantly different from those of monomicrobial chlamydial nongonococcal urethritis, most features were superimposed. Conclusions: Predicting causative microorganisms in men with non-gonococcal urethritis based on demographic and clinical features is difficult. However, the present study provides useful information to better understand the microbiological diversity in non-gonococcal urethritis, and to manage patients with non-gonococcal urethritis appropriately.

Prevalence of Polymicrobial Infection in Urethritis

“…The place of opportunistic pathogens in NGU and sexually transmissibility of NGU are also controversial (12). However, there are publications in the literature suggesting that Mycoplasma hominis, Gardnerella vaginalis, Candida albicans, and Ureaplasma species, which can be exist as normal commensal flora, cause urethritis at high microbial loads (2,13,14). Among these pathogens, only Ureoplasma ureolyticum is specified in the guidelines as a cause of urethritis (8).…”

“…Urethritis is an important cause of morbidity in sexually active individuals and remains a major medical, social and economic burden worldwide. Classically, urethritis is classified as non-gonococcal (NGU) and gonococcal (GU) (2). In the world, approximately 62 million new cases of GU and 89 million new cases of NGU are reported each year, and these figures keep increasing (3).…”

Infectious human adenoviruses are shed in urine even after disappearance of urethral symptoms

“…parvum (UP), Haemophilus influenzae (HI), human adenoviruses (HAdVs), herpes simplex virus (HSV), Streptococcus pneumoniae (SP), and Trichomonas vaginalis (TV). However, the transmission mechanisms and clinical characteristics of these causative agents remain unclear [1–3,5]. Recently, several epidemiological and case–control studies focusing on urethritis caused by HAdVs have been reported [2–8], but details regarding pathogenicity and clinical presentation are insufficient.…”

Value of light microscopy to diagnose urogenital gonorrhoea: a diagnostic test study in Indonesian clinic-based and outreach sexually transmitted infections services

“…2 21 22 N. meningitidis , for example, is commensal to human oro-pharynx but has also been described as a pathogen in urethritis in males. 22 In this study, however, we could exclude urogenital tract colonisation by N. meningitidis as an explanation for the PCR-negative and IGND-positive cases.…”