Urinary-tract infection in sexually active homosexual men

14 of 280 young, sexually active men with acute urinary symptoms had pronounced bacteriuria--13 with Escherichia coli and 1 with Staphylococcus saprophyticus. 12 of the 14 bacteriuric men were homosexual or bisexual, compared with 3 of 22 non-bacteriuric control patients. Pyuria and symptoms of cystitis were more common in the bacteriuric men, and these men frequently had a urethral discharge on examination, and non-gonococcal urethritis on gram stain of the discharge. The E coli strains causing cystourethritis in these men showed properties previously associated with acute-urinary-tract infection in women, including O serotype, haemolysin production, mannose-resistant haemagglutination of human erythrocytes, and P-fimbriation. Sexually active homosexual men are a newly identified group at increased risk of acute urinary-tract infection, and E coli may contribute to non-gonococcal urethritis in this population.