Horner P J, Thomas B, Gilroy C B, Egger M, Taylor-Robinson D
Genitourinary Medicine Section (formerly incorporating the MRC Sexually Transmitted Diseases Research Group), Department of Medicine (Division A), Imperial College School of Medicine, St Mary's Hospital, W2 1NY Paddington, London.
Int J STD AIDS. 2002 Oct;13(10):667-73. doi: 10.1258/095646202760326408.
We investigated the influence of symptoms and signs on the detection of Chlamydia trachomatis, Mycoplasma genitalium and Ureaplasma urealyticum organisms (ureaplasmas) in men with non-gonococcal urethritis (NGU). Two hundred and forty-two men attending the Jefferiss Wing at St Mary's Hospital for a sexual health assessment were evaluated, of whom 169 had NGU. Urethral inflammation was diagnosed if there were either > or =5 polymorphonuclear leucocytes (PMNLs) per high-power field (HPF) in five or more microscope fields of a Gram-stained urethral smear, or > or =10 PMNLs per HPF in five or more fields of a Gram-stained thread from 15-20 mL of a first-passed urine (FPU) specimen. C. trachomatis was diagnosed by direct immunofluoresence, M. genitalium by a polymerase chain reaction assay and ureaplasmas by culture. On multivariate analysis, to control for potential confounding by age, ethnicity, sexual lifestyle and co-infection, an urethral discharge remained significantly associated with the detection of C. trachomatis and M. genitalium in men with acute urethritis [OR 12.3, 95% CI (2.39-63.5) and OR 35.2, 95% CI (3.9-319.6), respectively], but dysuria or penile irritation did not. The detection of ureaplasmas was not associated with any clinical feature. In addition, on multivariate analysis men with NGU who were either symptomatic or had an observable discharge were more likely to have C. trachomatis or M. genitalium detected [(OR 6.92, 95% CI 1.41-33.9) and (OR 5.18, 95% CI 0.99-27.1), respectively], but not ureaplasmas (OR 1.19, 95% CI 0.33-4.35). The findings suggest that in men with acute NGU, symptoms or signs, and in particular a urethral discharge, are associated with the detection of C. trachomatis and M. genitalium, but not ureaplasmas. Currently, there is no precise answer to the question of whether all men attending a GUM clinic need to be screened for NGU, but if clinically asymptomatic NGU is found not to be associated with a sexually transmitted pathogen, the UK clinical guidelines requiring the preparation of a urethral smear from such men would need to be revised.
我们研究了症状和体征对非淋菌性尿道炎（NGU）男性沙眼衣原体、生殖支原体和解脲脲原体（脲原体）检测的影响。对在圣玛丽医院杰弗里斯翼部接受性健康评估的242名男性进行了评估，其中169名患有NGU。如果革兰氏染色尿道涂片的五个或更多显微镜视野中每个高倍视野（HPF）有≥5个多形核白细胞（PMNL），或者15 - 20毫升初段尿（FPU）标本的革兰氏染色棉拭子的五个或更多视野中每个HPF有≥10个PMNL，则诊断为尿道炎症。沙眼衣原体通过直接免疫荧光法诊断，生殖支原体通过聚合酶链反应测定法诊断，脲原体通过培养诊断。多因素分析中，为控制年龄、种族、性生活方式和合并感染的潜在混杂因素，尿道炎在急性尿道炎男性中与沙眼衣原体和生殖支原体的检测仍显著相关[比值比（OR）分别为12.3，95%置信区间（CI）（2.39 - 63.5）和OR 35.2，95% CI（3.9 - 319.6）]，但排尿困难或阴茎刺激与之无关。脲原体的检测与任何临床特征均无关联。此外，多因素分析显示，有症状或有明显分泌物的NGU男性更有可能检测到沙眼衣原体或生殖支原体[分别为（OR 6.92，95% CI 1.41 - 33.9）和（OR 5.18，95% CI 0.99 - 27.1）]，但与脲原体无关（OR 1.19，95% CI 0.33 - 4.35）。研究结果表明，在急性NGU男性中，症状或体征，尤其是尿道分泌物，与沙眼衣原体和生殖支原体的检测相关，但与脲原体无关。目前，对于所有到泌尿生殖医学门诊就诊的男性是否都需要筛查NGU这一问题尚无确切答案，但如果发现临床无症状的NGU与性传播病原体无关，那么英国要求对这类男性制备尿道涂片的临床指南可能需要修订。
