Article

Etiologies of nongonococcal urethritis: Bacteria, viruses, and the association with orogenital exposure

Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
The Journal of Infectious Diseases (Impact Factor: 5.78). 02/2006; 193(3):336-45. DOI: 10.1086/499434
Source: PubMed

ABSTRACT The purpose of the present study was to determine pathogens and behaviors associated with nongonococcal urethritis (NGU) and the usefulness of the urethral smear in predicting the presence of pathogens.
We conducted a case-control study of men with and without symptoms of NGU. Sexual practices were measured by questionnaire. First-stream urine was tested for Chlamydia trachomatis, Mycoplasma genitalium, Ureaplasma parvum, U. urealyticum, herpes simplex virus (HSV)-1, HSV-2, adenoviruses, and Gardnerella vaginalis by polymerase chain reaction.
C. trachomatis (20%), M. genitalium (9%), adenoviruses (4%), and HSV-1 (2%) were more common in cases with NGU (n = 329) after age and sexual risk were adjusted for (P< or =.01); U. urealyticum, U. parvum, and G. vaginalis were not. Infection with adenoviruses or HSV-1 was associated with distinct clinical features, oral sex, and male partners, whereas infection with M. genitalium or C. trachomatis was associated with unprotected vaginal sex. Oral sex was associated with NGU in which no pathogen was detected (P < or = .001). Fewer than 5 polymorphonuclear leukocytes (PMNLs) per high-power field (HPF) on urethral smear were present in 32%, 37%, 38%, and 44% of cases with C. trachomatis, M. genitalium, adenoviruses, and HSV, respectively.
We identified adenoviruses and HSV-1 as significant causes of NGU with distinct clinical and behavioral characteristics and highlighted the association between insertive oral sex and NGU. A urethral PMNL count of > or =5 PMNLs/HPF is not sufficiently sensitive to exclude pathogens in men with urethral symptoms.

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    • "Pharyngeal infection with gonorrhea or chlamydia is predominately asymptomatic (Bro-Jorgensen and Jensen, 1973; Jebakumar et al., 1995; Lafferty et al., 1997; Page- Shafer et al., 2002). Although pharyngeal pathology is uncommon (Metzger, 1970; Wiesner et al., 1973), there is evidence that these infections, as well as those caused by other sexually transmitted organisms as well as nonsexually transmitted organisms (Bradsha et al., 2006), can be transmitted from the pharynx to the genital tract of sex partners (Bro-Jorgensen and Jensen, 1973; Edwards and Carne, 1998; Lafferty et al., 1997; Soendjojo, 1983; Tice and Rodriguez, 1981), thereby contributing to overall STD "
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    ABSTRACT: Gonococcal and chlamydial infections in the pharynx can occur as a consequence of oral sex. Currently, diagnosis of these infections typically requires a swab specimen to be collected from the posterior pharynx. However, we assessed the diagnostic adequacy of using commercial mouthwash or water as an oral-throat rinse and subsequent testing with a nucleic acid amplification test (Gen-Probe APTIMA Combo 2 assay; Gen-Probe, San Diego, CA). Mouthwash and water samples, spiked with varying amounts of gonorrhea and chlamydia, remained positive for both organisms for up to 2 weeks after storage at room temperature and 37 degrees C. A clinical trial compared the test performance of oral-throat rinses to pharyngeal swabs among 561 (250 mouthwash, 311 water) gay and other men who have sex with men. Participants were also surveyed to assess the acceptability, preference, and feasibility of oral-throat rinses in a clinical setting. The prevalence of pharyngeal gonorrhea and chlamydia were 9.5% (53/556) and 1.4% (8/561), respectively. Compared with the pharyngeal swab, mouthwash oral-throat rinses had a sensitivity and specificity for the detection of gonorrhea of 72% and 99.1%, respectively, whereas water had 82% and 99.7%, respectively. Chlamydia prevalence was too low for reliable assessments of test performance. Study participants found oral-throat rinses acceptable, preferable, and feasible when compared with pharyngeal swabs. Further study is needed to investigate discordant results and improve the sensitivity of oral-throat rinses.
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    • "Adenoviruses were detected in 12 men ( 4% ) with NGU compared to one case ( 0 . 3% ) in the control group without urethritis in a study by Bradshaw et al . in 2006 . The two symptoms , severe dysuria and meatitis , were both associated with detection of adenovirus in this study ( 77 ) . "
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