Microscopy of Gram-stained urethral smear in the diagnosis of urethritis: Which threshold value should be selected?

Sarıer, Mehmet; Sepin, Nevgun; Duman, İbrahim; Demir, Meltem; Hizel, Aydan; Göktaş, Şafak; Emek, Mestan; Kukul, Erdal; Soylu, Ahmet

doi:10.1111/and.13143

Cited by 22 publications

(17 citation statements)

References 12 publications

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“…Recent studies recommended lowering the diagnostic criteria of the diagnosis to ≥2 PMNL/HPF due to false negative results obtained especially in NGU cases with mild inflammation (9,10). In a recent study conducted by Sarier et al (11), the authors showed that gram staining had 92.9% sensitivity in GU diagnosis and only 55.6% sensitivity in NGU when the threshold was ≥5 PMNL/HPF, while sensitivity in GU diagnosis increased to 100% and to 92.6% in NGU diagnosis when the cutoff value was lowered to ≥2 PMNL/HPF. Therefore, it must be noted that NGU cases can be missed in clinics where nucleic acid amplification assays such as PCR are not performed.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Polymicrobial Infection in Urethritis

Sarıer¹

2019

jus

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Üretrit erkeklerde en sık görülen cinsel yolla bulaşan hastalıktır ve patojenlerine göre gonokoksik (GU) ve non-gonokoksik üretrit (NGU) olarak sınıflandırılmaktadır. Son yıllarda artan üretrit olguları polimikrobial enfeksiyon varlığını da gündeme getirmiştir. Bu çalışmanın amacı üroloji polikliniğinde üretrit tanısı alan hastalarda gerçek zamanlı multiplex polimeraz zincir reaksiyonu (Rt-MPCR) sonuçlarına göre polimikrobial enfeksiyon prevelansının araştırılmasıdır.

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Section: Discussionmentioning

confidence: 99%

Prevalence of Polymicrobial Infection in Urethritis

Sarıer¹

2019

jus

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“…Clinical presentation can include urethral discharge, irritation, dysuria, or meatal pruritus ( 697 , 743 , 745 ). NGU is confirmed for symptomatic men when diagnostic evaluation of urethral secretions indicates inflammation, without evidence of diplococci by Gram, MB, or GV smear on microscopy ( 712 , 746 , 747 ). Visible discharge or secretions can be collected by a swab without inserting it into the urethra; if no visible secretions, the swab can be inserted into the urethral meatus and rotated, making contact with the urethral wall before removal.…”

Section: Diseases Characterized By Urethritis and Cervicitismentioning

confidence: 99%

Sexually Transmitted Infections Treatment Guidelines, 2021

Workowski¹,

Bachmann²,

Chan³

et al. 2021

MMWR Recomm. Rep.

1,571

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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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“…The same �5 PMN/HPF threshold was only 63% sensitive and 77% specific for C. trachomatis infection according to Haddow et al [22]. In a recent study by Sarier et al, the same threshold value demonstrated 92.9% sensitivity in the diagnosis of gonococcal urethritis (GU) and only 55.6% sensitivity in the diagnosis of non-gonococcal urethritis (NGU), but a threshold value of �2 PMNL/HPF reached 100% sensitivity for GU and 92.6% sensitivity for NGU [23]. A study performed by Rietmeijer et al showed that a significant 2.5-fold increase in chlamydia positivity (from 6.5% to 16.2%) occurred between the 1 and 2 PMNL/HPF strata supporting lowering the diagnostic criteria of the GSS diagnosis of male urethritis [24].…”

Section: Plos Onementioning

confidence: 95%

Profile of sexually transmitted infections causing urethritis and a related inflammatory reaction in urine among heterosexual males: A flow-cytometry study

2020

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Background Information about the use of flow cytometry in the diagnosis of male urethritis is scarce. The current study aims to evaluate the performance of flow cytometry on first-voided urine in males with infectious urethritis (Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium and Trichomonas vaginalis). Methods Male patients of the Andrology Centre (Tartu University Hospital, Estonia) were recruited during the period March 2015 –January 2018. Cases included 306 patients with infectious urethritis caused by Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium and/or Trichomonas vaginalis. The control group consisted of 192 patients without uro-genital complaints, negative tests for C. trachomatis, N. gonorrhoeae, M. genitalium and T. vaginalis from first-voided urine and no inflammation in first-voided urine, mid-stream urine and urine after prostate massage. C. trachomatis, N. gonorrhoeae, M. genitalium and T. vaginalis were detected from first-voided urine using polymerase chain reaction (PCR) method. First-voided urine was analysed using urine particle analyzer Sysmex UF-500i. Results The most prevalent infection was chlamydia (64.1%), followed by Mycoplasma genitalium (20.9%), gonorrhoea (7.8%) and trichomoniasis (1.6%). Gonorrhoea caused the highest flow-cytometric leucocyte/bacteria count, followed by chlamydia and Mycoplasma genitalium. Trichomonas vaginalis showed nearly absent inflammation in first-voided urine. Using an empiric flow-cytometry diagnostic threshold for urethritis in first-voided urine (leucocytes ≥ 15/μl and bacteria ≥ 20/μl) the total calculated sensitivity was over 90%. However, when applying such criteria for deciding whether to perform first-voided urine PCR for C. trachomatis, N. gonorrhoeae, M. genitalium and T. vaginalis or not, we could miss 23 cases with infectious urethritis that makes up 7,5% of all proven cases. Conclusions Flow cytometry of first-voided urine can be considered as a rapid and objective screening method in case of suspected male infectious urethritis.

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Microscopy of Gram-stained urethral smear in the diagnosis of urethritis: Which threshold value should be selected?

Cited by 22 publications

References 12 publications

Prevalence of Polymicrobial Infection in Urethritis

Prevalence of Polymicrobial Infection in Urethritis

Sexually Transmitted Infections Treatment Guidelines, 2021

Profile of sexually transmitted infections causing urethritis and a related inflammatory reaction in urine among heterosexual males: A flow-cytometry study

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