Zhou Chao-Feng, Wu Zhi-Gang, Li Cheng-di, Xiao Yun-Bei, Cai Jian
Department of Urology and Andrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China.
Zhonghua Nan Ke Xue. 2019 Sep;25(9):802-810.
To investigate the status quo of the diagnosis and treatment of male urethritis (MU) in urology and andrology.
According to The Guidelines for Clinical Diagnosis and Treatment of Sexually Transmitted Diseases (2017), we designed 27 questions on the prevalence, diagnosis, treatment, and prognosis of MU. Using these questions, we conducted a questionnaire investigation among urological, andrological and other relevant clinicians with different professional titles, followed by an analysis of the compliance of the doctors to the Guidelines.
Totally, 116 valid questionnaires were collected from 86 urological, 28 andrological and 2 other relevant doctors, including 22 professors, 36 associate professors, 40 attending doctors and 16 resident doctors. MU was found mostly in those aged 20－40 years and more than half of the patients had a history of unclean sex, gonococcal urethritis significantly less prevalent than non-gonococcal, with Ureaplasma urealyticum as the most common pathogen of non-gonococcal urethritis. As for the compliance to the Guidelines in the diagnosis of MU, 22.73% of the professors, 16.67% of the associate professors, 15.00% of the attending doctors and 12.50% of the resident doctors examined the eyes, mouth and perianus (P > 0.05), 40.91% of the professors, 58.33% of the associate professors, 40.00% of the attending doctors and 37.50% of the resident doctors conducted HIV and syphilis screening (P > 0.05), and 86.36% of the professors, 77.78% of the associate professors, 70.00% of the attending doctors and 75.00% of the resident doctors performed genital mycoplasma screening (P > 0.05). Concerning the treatment of MU, 50.00% of the professors, 47.22% of the associate professors, 22.50% of the attending doctors and 43.75% of the resident doctors used anti-Chlamydia trachomatis drugs for gonococcal urethritis (P > 0.05), 0.00% of the professors, 11.11% of the associate professors, 5.00% of the attending doctors and 31.25% of the resident doctors prescribed 1g single-dose oral azithromycin for non-gonococcal urethritis (P < 0.05), 13.64% of the professors, 33.33% of the associate professors, 17.50% of the attending doctors and 6.25% of the resident doctors medicated persistent or recurrent non-gonococcal urethritis for >4 weeks (P > 0.05), 63.64% of the professors, 83.33% of the associate professors, 57.50% of the attending doctors and 62.50% of the resident doctors treated asymptomatic trachomatis and mycoplasma infections according to the proposed medication in the Guidelines (P > 0.05). As regards the results of treatment, the cure rate of gonococcal urethritis was 100.00% by professors, 97.22% by associate professors, 95.00% by attending doctors and 81.25% by resident doctors (P > 0.05), and that of non-gonococcal urethritis was 86.36% by professors, 61.11% by associate professors, 62.50% by attending doctors and 37.50% by resident doctors (P < 0.05).
Urological and andrological clinicians do not strictly follow the Guidelines in the diagnosis and treatment of male urethritis. There are significant differences in the dosing of azithromycin and results of treatment of non-gonococcal urethritis among doctors with different professional titles, but not in the other aspects.
探讨泌尿外科及男科领域男性尿道炎（MU）的诊治现状。
依据《性传播疾病临床诊疗指南（2017年版）》，设计了27个关于MU的患病率、诊断、治疗及预后的问题。采用这些问题，对不同职称的泌尿外科、男科及其他相关临床医生进行问卷调查，随后分析医生对该指南的依从性。
共收集到来自86名泌尿外科医生、28名男科医生及2名其他相关医生的116份有效问卷，其中包括22名教授、36名副教授、40名主治医师及16名住院医师。MU多见于20 - 40岁人群，半数以上患者有不洁性行为史，淋菌性尿道炎的患病率显著低于非淋菌性尿道炎，解脲脲原体是非淋菌性尿道炎最常见的病原体。在MU诊断方面对指南的依从性上，22.73%的教授、16.67%的副教授、15.00%的主治医师及12.50%的住院医师检查了眼部、口腔及肛周（P>0.05）；40.91%的教授、58.33%的副教授、40.00%的主治医师及37.50%的住院医师进行了HIV及梅毒筛查（P>0.05）；86.36%的教授、77.78%的副教授、70.00%的主治医师及75.00%的住院医师进行了生殖道支原体筛查（P>0.05）。在MU治疗方面，50.00%的教授、47.22%的副教授、22.50%的主治医师及43.75%的住院医师对淋菌性尿道炎使用了抗沙眼衣原体药物（P>0.05）；0.00%的教授、11.11%的副教授、5.00%的主治医师及31.25%的住院医师对非淋菌性尿道炎开具1g单剂量口服阿奇霉素（P<0.05）；13.64%的教授、33.33%的副教授、17.50%的主治医师及6.25%的住院医师对持续性或复发性非淋菌性尿道炎用药超过4周（P>0.05）；63.64%的教授、83.33%的副教授、57.50%的主治医师及62.50%的住院医师根据指南建议的用药方案治疗无症状沙眼衣原体及支原体感染（P>0.05）。在治疗结果方面，教授治疗淋菌性尿道炎的治愈率为100.00%，副教授为97.22%，主治医师为95.00%，住院医师为81.25%（P>0.05）；教授治疗非淋菌性尿道炎的治愈率为86.36%，副教授为61.11%，主治医师为62.50%，住院医师为37.50%（P<0.05）。
泌尿外科及男科临床医生在男性尿道炎的诊治中未严格遵循指南。不同职称医生在阿奇霉素用药剂量及非淋菌性尿道炎治疗结果方面存在显著差异，但在其他方面无差异。
