Chandeying V, Skov S, Tabrizi S N, Kemapunmanus M, Garland S
Department of Obstetrics and Gynaecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand.
Int J STD AIDS. 2000 Apr;11(4):235-40. doi: 10.1258/0956462001915769.
The goal of this study was to determine whether a urine two-glass test or a leucocyte esterase (LE) test of first-void urine (FVU) improve the sensitivity or specificity of the World Health Organization (WHO) algorithm for the syndromic management of men with urethritis in southern Thailand. A secondary aim was to determine whether infection with Trichomonas vaginalis was sufficiently common to include treatment for it in a syndromic management protocol. One hundred and twenty-nine men with symptoms of urethritis seen at 2 STD clinics in Songkla Province, Thailand were enrolled. Symptoms and signs of each man were recorded and a urethral swab collected for microscopy and culture for Neisseria gonorrhoeae. A two-glass urine test and an LE test of an FVU specimen were performed. The FVU was tested by polymerase chain reaction (PCR) for N. gonorrhoeae, Chlamydia trachomatis and T. vaginalis. Dysuria was a symptom in 78% of men. A urethral discharge was a symptom in 68% but was evident on examination in 95% of the men. The prevalences of infection were 32.6% for N. gonorrhoeae, 23.3% for C. trachomatis, 1.6% for T. vaginalis and 51.9% for any infection. The sensitivities and specificities of urethral discharge on examination, two-glass test and LE test of FVU as indicators of infection with either or both of N. gonorrhoeae or C. trachomatis were 97% and 8%; 57% and 83%; and 59% and 78% respectively. Combinations of urethral discharge on examination and one of the other indicators were more specific but much less sensitive than the presence of discharge alone. Culture for N. gonorrhoeae was found to be only 43% sensitive compared with an expanded gold standard involving a PCR test. Our analysis demonstrates that neither the two-glass test nor the LE test of FVU were useful in improving on the WHO algorithm for management of men with urethritis. T. vaginalis was not common enough to include in a first-line syndromic management protocol for male urethritis. We recommend that, in southern Thailand, men with symptoms of urethritis in whom a urethral discharge is present on examination be offered immediate treatment for both N. gonorrhoeae and C. trachomatis as per the WHO algorithm.
本研究的目的是确定尿液两杯试验或首次晨尿（FVU）的白细胞酯酶（LE）试验是否能提高世界卫生组织（WHO）针对泰国南部男性尿道炎综合征管理算法的敏感性或特异性。第二个目的是确定阴道毛滴虫感染是否足够常见，从而将其治疗纳入综合征管理方案。在泰国宋卡府的2家性传播疾病诊所，招募了129名有尿道炎症状的男性。记录每名男性的症状和体征，并采集尿道拭子进行淋病奈瑟菌的显微镜检查和培养。对FVU标本进行两杯尿液试验和LE试验。通过聚合酶链反应（PCR）检测FVU中的淋病奈瑟菌、沙眼衣原体和阴道毛滴虫。78%的男性有排尿困难症状。68%的男性有尿道分泌物症状，但95%的男性在检查时可见尿道分泌物。淋病奈瑟菌感染率为32.6%，沙眼衣原体感染率为23.3%，阴道毛滴虫感染率为1.6%，任何一种感染的感染率为51.9%。检查时尿道分泌物、两杯试验和FVU的LE试验作为淋病奈瑟菌或沙眼衣原体感染指标的敏感性和特异性分别为97%和8%；57%和83%；以及59%和78%。检查时尿道分泌物与其他指标之一的组合更具特异性，但敏感性远低于单独存在尿道分泌物的情况。与采用PCR检测的扩展金标准相比，淋病奈瑟菌培养的敏感性仅为43%。我们的分析表明，尿液两杯试验和FVU的LE试验均无助于改进WHO针对男性尿道炎管理的算法。阴道毛滴虫不够常见，不足以纳入男性尿道炎的一线综合征管理方案。我们建议，在泰国南部，对于检查时有尿道分泌物的尿道炎症状男性，应按照WHO算法立即给予淋病奈瑟菌和沙眼衣原体治疗。
