Can a two-glass urine test or leucocyte esterase test of first-void urine improve syndromic management of male urethritis in southern Thailand?
Int J STD AIDS
; 11(4): 235-40, 2000 Apr.
Article
em En
| MEDLINE
| ID: mdl-10772086
ABSTRACT
The goal of this study was to determine whether a urine two-glass test or a leucocyte esterase (LE) test of first-void urine (FVU) improve the sensitivity or specificity of the World Health Organization (WHO) algorithm for the syndromic management of men with urethritis in southern Thailand. A secondary aim was to determine whether infection with Trichomonas vaginalis was sufficiently common to include treatment for it in a syndromic management protocol. One hundred and twenty-nine men with symptoms of urethritis seen at 2 STD clinics in Songkla Province, Thailand were enrolled. Symptoms and signs of each man were recorded and a urethral swab collected for microscopy and culture for Neisseria gonorrhoeae. A two-glass urine test and an LE test of an FVU specimen were performed. The FVU was tested by polymerase chain reaction (PCR) for N. gonorrhoeae, Chlamydia trachomatis and T. vaginalis. Dysuria was a symptom in 78% of men. A urethral discharge was a symptom in 68% but was evident on examination in 95% of the men. The prevalences of infection were 32.6% for N. gonorrhoeae, 23.3% for C. trachomatis, 1.6% for T. vaginalis and 51.9% for any infection. The sensitivities and specificities of urethral discharge on examination, two-glass test and LE test of FVU as indicators of infection with either or both of N. gonorrhoeae or C. trachomatis were 97% and 8%; 57% and 83%; and 59% and 78% respectively. Combinations of urethral discharge on examination and one of the other indicators were more specific but much less sensitive than the presence of discharge alone. Culture for N. gonorrhoeae was found to be only 43% sensitive compared with an expanded gold standard involving a PCR test. Our analysis demonstrates that neither the two-glass test nor the LE test of FVU were useful in improving on the WHO algorithm for management of men with urethritis. T. vaginalis was not common enough to include in a first-line syndromic management protocol for male urethritis. We recommend that, in southern Thailand, men with symptoms of urethritis in whom a urethral discharge is present on examination be offered immediate treatment for both N. gonorrhoeae and C. trachomatis as per the WHO algorithm.
Palavras-chave
Asia; Biology; Clinical Research; Delivery Of Health Care; Developing Countries; Diseases; Examinations And Diagnoses; Gonorrhea; Health; Health Services; Infections; Laboratory Examinations And Diagnoses; Laboratory Procedures; Men; Physiology; Primary Health Care; Reproductive Tract Infections; Research Methodology; Research Report; Sexually Transmitted Diseases; Southeastern Asia; Thailand; Treatment; Urogenital Effects--men; Urogenital System
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Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Tricomoníase
/
Uretrite
/
Hidrolases de Éster Carboxílico
/
Infecções por Chlamydia
/
Gonorreia
Tipo de estudo:
Etiology_studies
/
Guideline
Limite:
Animals
/
Humans
/
Male
País/Região como assunto:
Asia
Idioma:
En
Revista:
Int J STD AIDS
Assunto da revista:
SINDROME DA IMUNODEFICIENCIA ADQUIRIDA (AIDS)
Ano de publicação:
2000
Tipo de documento:
Article
País de afiliação:
Tailândia