Etiology of symptomatic urethritis in men and association with sexual behaviors (original) (raw)
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Study of partner-related and situational risk factors for symptomatic male urethritis
European Journal of Epidemiology, 2007
During the last decade, the incidence of male urethritis stopped declining in France. Risk factors associated with unprotected intercourse have been extensively studied in men who have sex with men, but not in men in general. The purpose of the study was to determine major risk factors for urethritis among men and to describe the sociodemographic and medical characteristics of this population in 2005. We conducted a prospective casecrossover study of sexual behaviors among men with acute urethritis attending at general practitioners or sexually transmitted infection (STI) clinics in France. Each patient filled out a selfcompleted questionnaire focusing on sociodemographic characteristics, and on sexual behaviors for the month before urethritis onset and for the preceding 3 months. The doctor reported medical information on a separate questionnaire. Between January and September 2005, 121 cases of male urethritis, defined as recent-onset pain on micturition and/or purulent or mucoid discharge, were included. Median age was 33 years, 22.3% were MSM, 55.1% were single, and 72.0% had at least high school education. Conditional logistic regression analysis showed that intercourse with only casual partners or with both casual and steady partners (OR = 2.6, CI 95%: 0.8-8.7, and OR = 8.7, CI 95%: 2.7-28.0), as well as inconsistent condom use (OR = 5.8, CI 95%: 1.7-19.2) significantly increased the risk of male urethritis. STI prevention campaigns should continue to focus on consistent condom use and should not neglect men over 30 years of age.
Journal of American college health : J of ACH, 2012
The study determined prevalence of asymptomatic nonurethral gonorrhea and chlamydia in men who have sex with men (MSM) seen at the Columbia University Health Service for routine care. The study enrolled 200 participants from March 2007 to May 2010. Specimens were tested using culture and nucleic acid amplification testing (NAAT): 3.5% (n = 7) tested positive for pharyngeal gonorrhea by NAAT, none were positive by culture; 3% (n = 6) tested positive for rectal chlamydia by NAAT and 0.5% (n = 1) by culture. The incidence of pharyngeal gonorrhea and rectal chlamydia in MSM who visited the Columbia Health Service was similar to rates of asymptomatic nonurethral gonorrhea and chlamydia in studies conducted in the MSM population in non-university settings. This suggests that, following the Centers for Disease Control and Prevention guidelines, 3-site testing for MSM seen at the Columbia clinic is indicated. NAAT is more sensitive than culture for nonurethral gonorrhea and chlamydia.
Sexually Transmitted Diseases, 2011
Background-Nongonococcal urethritis (NGU) is common, yet up to 50% of cases have no defined etiology. The extent to which risk profiles and clinical presentations of pathogenassociated and idiopathic cases differ is largely unknown. Methods-Urethral swabs and urine specimens were collected from 370 NGU treatment trial participants who sought care at a sexually transmitted disease clinic in Seattle, WA from 2007 to 2009 and had a visible urethral discharge and/or microscopic evidence of urethral inflammation assessed by Gram-stain (≥5 polymorphonuclear leukocytes per high-powered field [PMNs/HPF]). Neisseria gonorrhoeae, Chlamydia trachomatis (CT), Mycoplasma genitalium (MG), Trichomonas vaginalis (TV), and Ureaplasma urealyticum (UU) were detected in urine, using nucleic acid amplification tests. Cases negative for all assessed pathogens were considered idiopathic. Bivariate and multivariate analyses identified clinical, sociodemographic, and behavioral factors associated with detection of specific pathogens. Results-After excluding 3 participants with gonococcal infection, pathogens were detected in only 50.7% of the 367 eligible cases: CT in 22.3%, MG in 12.5%, TV in 2.5%, and UU in 24.0%, with multiple pathogens detected in 9.5%. In all, 3.5% of cases were negative for CT, MG, and TV but lacked speciated ureaplasma results. The remaining cases (45.8%) were considered idiopathic. Pathogen detection was associated with young age, black race, risky sexual behaviors, cloudy or purulent discharge, and visible discharge plus ≥5 PMNs/HPF. In contrast, idiopathic
Cancer Causes & Control, 2009
Objective-Several epidemiologic studies have investigated sexually transmitted infections (STIs) and later risk of genitourinary conditions with suggestive positive results. While these results may reflect causal associations, other possible explanations include confounding by factors possibly related to both STI acquisition and genitourinary condition risk, such as recognized STI risk factors/ correlates, and other factors not typically considered in relation to STIs (e.g., general health-related behaviors or markers of such behaviors). Very few of these factors have been investigated in older populations in which STIs and genitourinary conditions are typically studied. Therefore, we investigated STI history correlates in one such population, the Health Professionals Follow-up Study.
Clinical Infectious Diseases, 2014
Background. Gonorrhea (GC) and chlamydia (CT) are the most commonly reported notifiable diseases in the United States. The Centers for Disease Control and Prevention recommends that men who have sex with men (MSM) be screened for urogenital GC/CT, rectal GC/CT, and pharyngeal GC. We describe extragenital GC/CT testing and infections among MSM attending sexually transmitted disease (STD) clinics. Methods. The STD Surveillance Network collects patient data from 42 STD clinics. We assessed the proportion of MSM attending these clinics during July 2011-June 2012 who were tested and positive for extragenital GC/CT at their most recent visit or in the preceding 12 months and the number of extragenital infections that would have remained undetected with urethral screening alone. Results. Of 21 994 MSM, 83.9% were tested for urogenital GC, 65.9% for pharyngeal GC, 50.4% for rectal GC, 81.4% for urogenital CT, 31.7% for pharyngeal CT, and 45.9% for rectal CT. Of MSM tested, 11.1% tested positive for urogenital GC, 7.9% for pharyngeal GC, 10.2% for rectal GC, 8.4% for urogenital CT, 2.9% for pharyngeal CT, and 14.1% for rectal CT. More than 70% of extragenital GC infections and 85% of extragenital CT infections were associated with negative urethral tests at the same visit and would not have been detected with urethral screening alone. Conclusions. Extragenital GC/CT was common among MSM attending STD clinics, but many MSM were not tested. Most extragenital infections would not have been identified, and likely would have remained untreated, with urethral screening alone. Efforts are needed to facilitate implementation of extragenital GC/CT screening recommendations for MSM. Keywords. extragenital gonorrhea; extragenital chlamydia; men who have sex with men (MSM); STD. Gonorrhea (GC) and chlamydia (CT) are the 2 most commonly reported notifiable diseases in the United States, with >149 000 cases of GC and >380 000 cases of CT among men reported to the Centers for Disease Control and Prevention (CDC) in 2011 [1]. Surveillance data suggest that men who have sex with men (MSM) are disproportionately affected by sexually transmitted diseases (STDs) [1].
Factors associated with genital chlamydial and gonococcal infection in males
Sexually Transmitted Infections, 1993
Background-Predictors of chlamydia and gonorrhoea can be used to increase the cost-effectiveness and acceptability of screening programmes, and allow targeting of control strategies. Methods-All women attending an STD clinic in 1988-1990 were offered screening for chlamydia and gonorrhoea, and the test results correlated with a wide range of potential predictors using multiple logistic regression. Results-Of 4822 attenders, 3533 (73.3%) were tested for chlamydia over a total of 5430 episodes, yielding 348 (6.4%) positives, and 3510 (72.8%) were tested for gonorrhoea over a total of 5450 episodes, yielding 100 (1.0%) positives. Independent predictors of chlamydial infection were being an STD contact, having endocervical gonorrhoea, being under 25, not having genital herpes, being Aboriginal, using oral contraception, not having a steady partner and having vaginal discharge or dysuria. For gonorrhoea such predictors were being Aboriginal, an STD contact, under 25, tattooed, having vaginal discharge or dysuria, and having had sex outside the state in the past three months. Selective screening criteria for gonorrhoea provided 91% ofpositives, eliminated the need for 42% oftests and resulted in an increased yield ratio of 1.5 whereas the corresponding outcomes for screening criteria for chlamydia were 91%, 29%'/o and 1*3, respectively. Conclusions-The diversity of STD epidemiology requires development of empirical screening guidelines for diverse settings. Standardisation of methodology to facilitate comparisons and extrapolation should include investigation of a wide range ofvariables, available before patient examination, by multivariate analysis, and choice of selective criteria to cover at least 90% ofthe infected popuilation as well as resulting in a substantially increased yield (preferably an increased yield ratio of at least 1.5).
Sexually Transmitted Infections, 2006
Background: Early detection and treatment of bacterial sexually transmitted infections has been advocated as an HIV prevention strategy. Aim: To inform screening guidelines, the incidence and risk factors for urethral and anal gonorrhoea and chlamydia were studied in a prospective cohort of community-based HIV negative homosexual men in Sydney, New South Wales, Australia. Methods: All participants were offered annual screening for gonorrhoea and chlamydia (study-visit diagnoses) on urine and anal swabs using nucleic acid amplification. Participants also reported diagnoses of gonorrhoea and chlamydia made elsewhere between interviews (interval diagnoses). All diagnoses were summed to create a combined incidence rate, and detailed data on specific sexual practices with casual and regular partners were collected. Results: Among 1427 men enrolled, the combined incidence rates were 3.49 and 2.96 per 100 person-years for urethral and anal gonorrhoea, respectively; and 7.43 and 4.98 per 100 person-years for urethral and anal chlamydia, respectively. Urethral infections were associated with unprotected anal intercourse (UAI) with HIV-positive partners (hazard ratio (HR) = 2.58, 95% CI 1.10 to 6.05 for urethral gonorrhoea) and with frequent insertive oral sex (p for trend 0.007 for urethral chlamydia). Anal infections were associated with receptive UAI (p for trend 0.001 for both anal gonorrhoea and chlamydia) and other receptive anal sexual practices. Stratified analyses showed the independence of the associations of insertive oral sex with urethral infections and of non-intercourse receptive anal practices with anal infections. Conclusion: Incident gonorrhoea and chlamydia were common. Risk behaviours for both urethral and anal infections were not restricted to UAI. Screening that includes tests for anal and urethral infections should be considered for all sexually active homosexual men, not just for those who report UAI.
Men at risk of gonococcal urethritis: a case-control study in a Darwin sexual health clinic
BMC Infectious Diseases, 2019
Background Male urethritis is primary sexually transmitted. Northern Territory (NT) has the highest rates of gonococcal infection in Australia and local guidelines recommend empiric treatment with azithromycin and ceftriaxone for all men presenting with urethritis. As gonococcal drug resistance is a growing concern, this study aims to improve empiric use of ceftriaxone through examining local patterns of male urethritis, comparing cases of gonococcal urethritis (GU) to controls with non-gonococcal urethritis (NGU). Methods A retrospective study was undertaken of all men with symptomatic urethritis presenting to Darwin sexual health clinic from July 2015 to July 2016 and aetiology of urethritis in this population was described. Demographic, risk profile, and clinical features of GU cases were compared to NGU controls. Results Among n = 145 men, the most common organisms identified were Chlamydia trachomatis (23.4%, SE 3.5%) and Neisseria gonorrhoeae (17.2%, SE 3.1%). The main predict...