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Sexual preference as a predictor of pathogen detection in 4326 cases of acute NGU

Sexual preference as a predictor of pathogen detection in 4326 cases of acute NGU

Introduction: Non-gonococcal urethritis (NGU) is a common but poorly understood clinical syndrome. Little has been published on aetiological agents with respect to sexual preference. This large series examines epidemiological and laboratory characteristics in acute NGU.

Methods: Retrospective review using the electronic medical-record database of Melbourne Sexual Health Centre, Australia, from January 2006 to December 2011. Cases were men with first presentation of symptomatic acute NGU. First-stream urine was routinely tested for C.trachomatis and M.genitalium by PCR, and selectively tested, for trichomoniasis by culture, HSV-1/2 and adenoviruses by PCR. To explore characteristics associated with pathogens, analyses were conducted stratifying by pathogen, pathogen-clusters and sexual preference. results: Of 5452 acute NGU cases, 4326(79%) first presentations were included; 799(19%) had C.trachomatis and 264(6%) M.genitalium detected. Viruses and trichomoniasis were tested selectively. Compared to heterosexual cases (MSW ), MSM (men who have sex with men) were less likely to have C.trachomatis(OR=0.5; 0.4-0.6) or M.genitalium(0.6; 0.5-0.9), more likely to report consistent condom use for anal/vaginal sex (AOR=3.9; 3.3-4.7) or only unprotected oral sex (UPOS) (14.5, 8.7-24.3). Pathogen-negative-NGU, when compared to bacterial-NGU, was significantly associated with exclusive UPOS (AOR=1.9, 1.2-3.0) and consistent condom use for anal/vaginal sex (AOR=2.1, 1.7-2.6); viral-NGU had similar characteristics to pathogen-negative NGU. Only 63% cases with bacterial-NGU and 32% with viral-NGU had ≥5 PMNL/HPF on urethral Gram-stain.

Conclusion: C.trachomatis or M.genitalium are less common in MSM with acute NGU compared to MSW. Pathogen-negative and viral-NGU have similar epidemiological characteristics; associated with recent sexual activity with males and report of low-risk practices such as oral sex and protected anal sex. These data indicate that the aetiologic spectrum of pathogens differs between MSM and MSW in acute NGU and behavioural associations implicate the oropharynx as a likely source of infection. Further identification of pathogens responsible for currently pathogen-negative NGU is required including possible oral pathogens. Disclosure of Interest Statement: None.

Speakers: Vinita Rane
Areas of Interest / Categories: AIDS 2014

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