Men at risk of gonococcal urethritis: a case-control study in a Darwin sexual health clinic

Chen, Winnie; Connor, Suzanne; Gunathilake, Manoji

Men at risk of gonococcal urethritis: a case-control study in a Darwin sexual health clinic

Files

12879_2019_Article_4625.pdf (758.25 KB)

Authors

Chen, Winnie

Connor, Suzanne

Gunathilake, Manoji

Issue Date

2019-11-21

Type

Article

Language

en_US

Keywords

Urethritis , Men , Neisseria Gonorrhoeae , Chlamydia Trachomatis , Ceftriaxone , Antimicrobial Resistance

Abstract

Background: Male urethritis is primary sexually transmitted. Northern Territory (NT) has the highest rates of gonococcal infection in Australia and local guidelines recommend empiric treatment with azithromycin and ceftriaxone for all men presenting with urethritis. As gonococcal drug resistance is a growing concern, this study aims to improve empiric use of ceftriaxone through examining local patterns of male urethritis, comparing cases of gonococcal urethritis (GU) to controls with non-gonococcal urethritis (NGU). Methods: A retrospective study was undertaken of all men with symptomatic urethritis presenting to Darwin sexual health clinic from July 2015 to July 2016 and aetiology of urethritis in this population was described. Demographic, risk profile, and clinical features of GU cases were compared to NGU controls. Results: Among n = 145 men, the most common organisms identified were Chlamydia trachomatis (23.4%, SE 3.5%) and Neisseria gonorrhoeae (17.2%, SE 3.1%). The main predictors of GU were any abnormalities on genital examination (aOR 10.4, 95% CI 2.1 to 50.8) and a history of urethral discharge (aOR 5.7, 95% CI 1.4 to 22.6). Aboriginal patients (aOR 3.0, 95% CI 0.9 to 9.6) and those over 30 years of age (aOR 1.4, 95% CI 0.3 to 7.0) were more likely to have GU in the unadjusted analysis, but not in the adjusted model. Conclusion: This is the first study looking at patterns of male urethritis in urban NT and the results support a move towards adopting national guidelines to use ceftriaxone for empiric management of syndromic urethritis only in high-risk patients. In addition to traditional demographic risk factors, clinical features remain an important component of risk stratification.

Citation

Chen, W., Connor, S., & Gunathilake, M. (2019). Men at risk of gonococcal urethritis: a case-control study in a Darwin sexual health clinic. BMC infectious diseases, 19(1), 991. https://doi.org/10.1186/s12879-019-4625-8

Publisher

BMC Infectious Diseases