B3c Asymptomatic Urethritis Is Associated with Characteristics That Suggest Sexually Transmitted Etiology Above and Beyond the Role of Recognized Sexually Transmitted Pathogens

Tuesday, March 9, 2010: 3:45 PM
Grand Ballroom A (M4) (Omni Hotel)
Catherine M. Wetmore, MPH1, Lisa E. Manhart, MPH, PHD1, M. Sylvan Lowens, PA2, Sarah J. McDougal, BA1, Matthew Golden, MPH, MD3, William L. H. Whittington, AB4, Ana Maria Xet-Mull, MSc, MPH4, Nicole L. McFarland, BS4, Sabina G. Astete, PhD4 and Patricia A. Totten, PhD5, 1Department of Epidemiology and Center for AIDS and STD, University of Washington, Seattle, WA, 2Public Health - Seattle & King County STD Clinic, Seattle, WA, 3Center for AIDS and STD, University of Washington, Seattle, WA, 4Department of Medicine, University of Washington, Seattle, WA, 5Department of Medicine and Center for AIDS and STD, University of Washington, Seattle, WA

Background: The prevalence and clinical significance of asymptomatic urethritis is poorly defined.

Objectives: Identify characteristics associated with asymptomatic urethritis.

Methods: From July 2007-September 2009, we recruited 236 men who denied urethral symptoms or antibiotic use in the prior month from an Emergency Department (ED) waiting area.  Men completed face-to-face and computer interviews. We collected urethral swabs and tested urine specimens for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) using APTIMA Combo 2®, Trichomonas vaginalis (TV) using research-use only APTIMA® TMA (Gen-Probe, Inc.), and Mycoplasma genitalium (MG) using in-house PCR. Asymptomatic urethritis was defined as ≥5PMN/HPF averaged over ≥3 fields on a urethral Gram-stain. Negative binomial regression identified factors independently associated with asymptomatic urethritis.

Results: Among these 236 men, mean age was 37 years (range 16-63). Asymptomatic urethritis was detected in 38 (16%). 16 (42%) of 38 men with ≥5PMN/HPF and 4 (2%) of 198 men with <5PMN/HPF had unrecognized visible discharge on examination. CT, MG and/or TV were detected in 6 (16%) with ≥5PMN/HPF and 8 (4%) with <5PMN/HPF. In multivariable analyses adjusting for age and race, asymptomatic urethritis was associated with detection of the above pathogens (aRR=2.6; 95%CI:2.0-3.3), ≥2 hours since last voiding (aRR=2.6; 95%CI:1.4-4.7), reporting insertive anal sex in the prior two months (aRR=2.2; 95%CI:1.9-2.6), being uncircumcised (aRR=1.7; 95%CI:1.5-2.0), and more sex partners in the prior two months (aRR=1.1 per partner; 95%CI:1.1-1.2). Results did not change when pathogen-positive men were excluded.

Conclusions: Asymptomatic urethritis was not uncommon in this population. Approximately 40% of these cases had unrecognized signs of urethritis. Behavioral and physiological correlates of asymptomatic urethral inflammation were similar in men with and without identified pathogens, suggesting a role for undetected sexually transmitted organisms.

Implications for Programs, Policy, and/or Research: Routine genital examination seems warranted to identify asymptomatic urethritis.  Future research should investigate the clinical implications and appropriate management of asymptomatic urethritis.