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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.