From the Department of Urology, Istinye University, Istanbul.
Department of Clinical Biochemistry, Medical Park Hospital, Antalya.
Sex Transm Dis. 2020 Oct;47(10):712-715. doi: 10.1097/OLQ.0000000000001228.
The effectiveness of microscopy of Gram-stained smear (GSS) for the detection of male urethral infection is debatable, especially in cases with low inflammation and no visible urethral discharge. This clinical study compared GSS samples collected with the conventional swab method and our new technique, the kissing slide method, together with polymerase chain reaction results to demonstrate the effectiveness of this new method in men with acute urethritis.
The study included 64 men who presented to the urology outpatient clinic with complaints of acute urethritis between October 2019 and January 2020. Two GSS samples were collected from each patient, first using the kissing slide method (applying the slide directly to the urethral mucosa), followed by the conventional method. The results were compared with polymerase chain reaction findings.
The patients' mean age was 37.4 ± 7.8 years, and 68.7% had no visible urethral discharge on physical examination. At a GSS threshold of ≥5 polymorphonuclear leukocytes/high-power field, sensitivity values were 60% (95% confidence interval [CI], 42.32%-75.41%) for the kissing slide method and 23.33% (95% CI, 11.79%-40.93%) for the conventional method. At a threshold of ≥2 polymorphonuclear leukocytes/high-power field, sensitivity values with the kissing slide and conventional methods were 80% (95% CI, 62.69%-90.5%) and 50% (95% CI, 33.15%-66.85%) in all patients, and 66.67% (95% CI, 41.71%-84.82%) and 20% (95% CI, 7.047%-45.19%) in cases without visible urethral discharge, respectively.
The new kissing slide method is a noninvasive alternative method that may have better sensitivity than the conventional GSS sampling method in the diagnosis of male acute urethritis. Randomized studies are needed to verify these findings.
革兰氏染色涂片（GSS）显微镜检查对男性尿道感染的检测效果存在争议，尤其是在炎症程度低且无可见尿道分泌物的情况下。本临床研究比较了传统拭子法和我们的新方法，即接吻片法收集的 GSS 样本与聚合酶链反应结果，以证明这种新方法在急性尿道炎男性患者中的有效性。
该研究纳入了 2019 年 10 月至 2020 年 1 月间因急性尿道炎就诊于泌尿科门诊的 64 名男性患者。每位患者采集了 2 份 GSS 样本，首先使用接吻片法（直接将玻片应用于尿道黏膜），然后使用传统方法。将结果与聚合酶链反应结果进行比较。
患者的平均年龄为 37.4 ± 7.8 岁，68.7%的患者在体格检查时无可见尿道分泌物。在 GSS 中，当白细胞≥5 个/高倍视野时，接吻片法的敏感性为 60%（95%置信区间 [CI]，42.32%-75.41%），而传统方法的敏感性为 23.33%（95% CI，11.79%-40.93%）。当阈值为≥2 个白细胞/高倍视野时，接吻片法和传统方法的敏感性在所有患者中分别为 80%（95% CI，62.69%-90.5%）和 50%（95% CI，33.15%-66.85%），在无可见尿道分泌物的患者中分别为 66.67%（95% CI，41.71%-84.82%）和 20%（95% CI，7.047%-45.19%）。
新的接吻片法是一种非侵入性的替代方法，在诊断男性急性尿道炎方面可能比传统的 GSS 采样方法具有更高的敏感性。需要进行随机研究来验证这些发现。
