ATLANTA — Urethritis is relatively common even in men reporting no urethral symptoms, according to study findings suggesting that routine genital examination may help diagnose unsuspected sexually transmitted diseases.
Of 236 men, aged 16-63, recruited from a Seattle emergency department waiting room who reported having no urethral symptoms, 16% had microscopic evidence of inflammation and nearly half of those men (7% of the total group) had discharge visible upon examination. Another 2% of men had visible discharge without microscopic evidence of inflammation, Catherine M. Wetmore reported at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.
“Conventional wisdom suggests that women frequently experience asymptomatic reproductive tract infections but that men are generally more aware of potential signs/symptoms of infection,” she noted in a statement. Yet urethral discharge was visible in nearly 10% of these men reporting no urethral symptoms. Moreover, 80% of men with visible discharge had microscopic evidence of urethral inflammation (at least five polymorphonuclear neutrophils per high-power field over at least three fields on a urethral gram-stain).
Ms. Wetmore, of the University of Washington, Seattle, and her colleagues also evaluated the incidence of sexually transmitted infections (STIs) in these men. Nearly one in five men (18%) with asymptomatic urethritis, and 4% of men without urethritis, had detectable STIs, including Mycoplasma genitalium (9% and 2%), Chlamydia trachomatis (8% and 2%), and Trichomonas vaginalis (3% and 1%). No cases of gonorrhea were detected.
Patients were an average of 37-39 years old; 52% were African American, 33% were white, 2% were Asian/Pacific Islander, and the remainder were other races.
In a multivariate analysis, factors independently associated with an increased risk of asymptomatic urethritis included having a detected STI, older age, race (African American vs. white), having a greater number of recent sex partners, being uncircumcised, having had recent anal sex, and having voided at least 2 hours before the exam.
Ms. Wetmore noted that her findings suggest that a genital exam may provide an opportunity to diagnose and treat unsuspected sexually transmitted infections.
Disclosures: Ms. Wetmore reported having no conflicts of interest.