Session: MP15: Infections/Inflammation/Cystic Disease of the Genitourinary Tract: Prostate & Genitalia
MP15-18: Urethral discharge is predictive of gonococcal or chlamydial infection in patients with urethritis symptoms but negative urinalysis and urine culture
Division of Urology, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University
Introduction: Urethritis is most commonly caused by sexually-transmitted pathogens among young males, while other non-infectious diseases may also result in similar symptoms. The diagnosis of the pathogen of urethritis based on urine culture (UC) is sometimes challenging. PCR is costly and is not available in every clinic. We analyzed the predictors of positive PCR in urethritis patients with negative urinalysis (UA) and UC. Methods: Young adult male patients (20 - 50 years of age) with symptoms of urethritis visiting our clinic from March 2019 to April 2022 were retrospectively recruited. All the patients received UA, UC, and urinary PCR testing gonorrhea and chlamydia at the first visit. Treatments were given and patients were asked to come back one week later. Univariate and multivariate logistic regression were used to evaluate the predictors of positive PCR of gonorrhea or chlamydia in patients with negative UA and UC. Results: A total of 365 young adult males with symptoms of urethritis were included. Patients with negative UA, UC, and PCR were significantly older (37 ± 9.5 vs 34.0 ± 8.2 years, p = 0.001), but less frequent report of urethral discharge (8.5% 82.1%, p < 0.001) than those with at least one positive test. Among 202 patients with negative UA and UC, 60 (29.7%) were diagnosed with gonorrhea or chlamydia by PCR. The presence of discharge was an independent predictor of positive PCR of gonorrhea or chlamydia infection (OR 32.669, 95% CI 13.67 - 78.09, p<0.001). Among 142 young adult males with symptoms of urethritis but negative UA, UC, or PCR, empirical treatments included empirical antibiotics (68.3%), phenazopyridine (28.2%), a-blockers (19.7%), and NSAIDs (16.9%). Symptoms subsided after treatment in all these patients at one-month follow-up. Flow chart of management was suggested as Figure. Conclusions: Young male patients with gonorrhea or chlamydia infection were frequently negative for UA and UC. A history of urethral discharge could be an indicator of antibiotic treatment against gonorrhea and chlamydia in those without pyuria on UA. For those with negative UA, UC, and PCR, the prognosis is good, and the urologists could provide empirical treatments based on their clinical judgement and reassure the patients. SOURCE OF Funding: nil
