Urinary tract infection in patients with acute non-gonococcal urethritis

In young sexually active male patients, clinical differentiation between non-gonococcal urethritis (NGU) and urinary tract infection (UTI) can be difficult. UTI as a cause of NGU has been suggested before, but the prevalence of UTI among acute NGU patients has not been evaluated. We conducted a prospective cross-sectional study of 156 male patients with clinical features of acute urethritis. The prevalence of UTI among acute NGU patients was 6.4% (CI: 1.5-11.3%). There was a possible association between UTI and NGU but this was not statistically significant. The sensitivity and specificity for combining leucocyte esterase and nitrite tests were 83.3% and 89.8%, respectively, with a negative predictive value of 98.8%. We conclude that a mid-stream urine specimen should routinely be collected in patients with symptoms of urethritis. This should be analysed by dipsticks incorporating nitrite and leucocyte esterase tests. Those with a positive dipstick should then be confirmed by culture.