Question
Is there a need for preparation of a urethral smear from clinically asymptomatic men attending GUM departments?
Design
The correlation of symptoms, signs, and microscopy with the detection of C. trachomatis infection using an amplification assay in men attending a GUM clinic was investigated.
Participants
One hundred eleven heterosexual (75.7%) or homosexual (21.6%) men who were diagnosed with C. trachomatis infection at a GUM clinic in London, with or without symptoms of urethritis, were evaluated. The median age was 28 years (range = 16-61 years).
Description of Tests and Diagnostic Standard
Symptomatic patients complained of discharge, dysuria, or penile irritation and had observable meatal inflammation or urethral discharge on examination. A plastic loop was inserted into the urethra, smeared on a microscopic slide, and Gram stained. Nongonococcal urethritis (NGU) was diagnosed by detection of > 5 polymorphonuclear leukocytes (PMNLs) per high-power microscope field (HPF) of the urethral smear or > 10 PMNLs per HPF in a Gram-stained preparation of a first passed urine specimen. A second urethral specimen was taken using a cotton-tipped swab for C. trachomatis testing by strand displacement amplification (SDA).
Main Outcome Measures
The relationship between the presence of symptoms and diagnosis of NGU by microscopy among 111 men with C. trachomatis infection detected by SDA was determined.
Main Results
Among the 111 men with C. trachomatis detected by SDA, the number and proportion of men with symptoms of NGU and a diagnosis of NGU by microscopy are shown in the table. Twenty-one (19%) of the 111 men were asymptomatic but positive for NGU by microscopy.
Relationship between symptoms and diagnosis of NGU among 111 men positive for C. trachomatis by SDA
|
Symptoms of NGU
|
NGU diagnosed by microscopy, n (%)
|
|
Positive
|
Negative
|
Total
|
|
Positive
|
59 (84)
|
11 (16)
|
70 (63)
|
|
Negative
|
21 (51)
|
20 (49)
|
41 (37)
|
|
Total
|
80 (72)
|
31 (28)
|
111
|
Authors’ Conclusions
Detection of NGU on routine microscopy of asymptomatic men facilitated the early treatment of 19% of men subsequently diagnosed with chlamydia. The current practice of testing asymptomatic men attending GUM clinics for NGU should continue.
Source of funding: None given
For correspondence: Rita Browne, Specialist Registrar GU/HIV Medicine, St Stephens Centre, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK. E-mail address: rita.browne@chelwest.nhs.uk
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