Male urethritis with and without discharge: a clinical and microbiological study

The definition of male urethritis in the absence of urethral discharge has not been well established. The sensitivity of urethral swabs and first-catch urine is controversial.

To correlate clinical data (discharge or not), urethral swabs, and first-catch urine examinations with the microorganisms found within the urethra in a cohort of men attending the sexually transmitted disease clinic of Hôpital Saint Louis (Paris) for treatment of urethral symptoms with or without discharge.

Two-hundred-seventy-three consecutive male patients entered this prospective study between October 1, 1992 and November 30, 1992. Fifty-two patients were excluded because they had been treated with antibiotics in the previous 3 months. All patients were screened for Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Trichomonas vaginalis, Ureaplasma urealyticum, Mycoplasma hominis, and Candida albicans.

Two-hundred-nineteen patients were eligible for the study (122 with discharge and 97 with no discharge). The prevalence of microorganisms was as follows: Chlamydia trachomatis in 13%, Neisseria gonorrhoeae in 11%, Ureaplasma urealyticum in 7%, Mycoplasma genitalium in 17%, Trichomonas vaginalis in 1%, and indeterminate pathogens alone in 20%. All major pathogens and Mycoplasma genitalium were more common in patients with discharge. Stratification of results according to the presence of polymorphonuclear leukocytes on the urethral swab and first-catch urine showed a low sensitivity of both tests for Chlamydia trachomatis (29%), Mycoplasma genitalium (50% and 62%), and Ureaplasma urealyticum (33%) in patients with no discharge.

A specific and sensitive search for Chlamydia trachomatis should be done in every patient with urethral symptoms whether or not the classic symptoms of urethritis are present (discharge, presence of polymorphonuclear leukocytes in the urethra or first-catch urine).