AEGiS-11IAC: Acute urethritis among men in Nairobi, Kenya: etiologic diagnosis, syndromic treatment & association with HIV-1.

11th International AIDS Conference

Vancouver, British Columbia — July 7-12, 1996

Acute urethritis among men in Nairobi, Kenya: etiologic diagnosis, syndromic treatment & association with HIV-1.

Int Conf AIDS 1996 Jul 7-12; 11:219 (abstract no. Th.B.112)
Taelman H, Tyndall MW, Gichangi P, Omollo DO, Omar S, Ombete J, Mohamedali FY, Ndinya-Achola J, Temmerman M; University of Nairobi, Department of Medical Microbiology, Nairobi, Kenya. Fax: 254 2 442082.

OBJECTIVES: 1. To determine the prevalence of urethral pathogens, syphilis and HIV-1 infection among patients with acute urethritis (AU); 2. To asses the accuracy of the clinical diagnosis in this population; 3. To evaluate the diagnostic usefulness of the leukocytes esterase (LE) test in urine. 4. To assess the efficacy of amoxycyllin 3g-Augmentin 375 mg-probenecid 1g single dose combined with tetracycline 500mg qid x 7 days as syndromic treatment of AU.

METHODS: Each new patient presenting with AU, without previous treatment, had the following investigations carried out after informed consent was obtained: medical history including behavioural and demographic information; clinical examination; laboratory tests including N.gonorrhoeae (GC), C. trachomatis, T.vaginalis, Mycoplasma, Ureaplasma in urethral exudate, LE test on urine specimen, HIV-1 and syphilis tests on serum. Patients were asked to come for follow-up at day 7.

RESULTS: 399 patients (mean age: 28 y; 50% with 2-3 partners over past 3 months; history of previous STD: 56%, O.R. for HIV+:1.8) were enrolled over a period of 6 months. Prevalence rates were: GC 68%, C. trachomatis 9%, T. vaginalis 6%, Ureaplasma 6%, Mycoplasma 6%. Mixed infections were found in 15% of the patients. Prevalence rates of HIV-1 and syphilis were 14% and 9% respectively. The sensitivity and positive predictive value (PPV) of the clinical diagnosis of GC infection for positive GC culture were 95%, 46% and 79% respectively while for the diagnosis of non GC infection compared to non GC pathogens isolation these values were 25%, 84% and 32% respectively. The PPV of LE test for urethral pathogens was 96% at a cut off value of 1+. Of 198 patients seen at follow-up, 168 (85%) were cured or improved with the syndromic treatment.

CONCLUSIONS: In Nairobi, 1) GC is by far the most common pathogen in men with AU; HIV-1 and syphilis are moderately associated with AU; 2) Differentiation between GC and non-GC infection cannot rely on clinical basis, justifying the syndromic approach of treatment when laboratory is not available; 3) LE is of predictive usefulness in diagnosis of AU; 4) Due to the high lost to-follow-up rate, no conclusions could be made on the effectiveness of the syndromic treatment but it appears that non GC is overtreated; T. vaginalis should be considered in non responders and treated appropriately.

Keywords: AEGIS, Urethritis, Chlamydia Infections, Neisseria gonorrhoeae, Gonorrhea, HIV-1, Chlamydia trachomatis, Sexually Transmitted Diseases, HIV Infections, Mycoplasma Infections, Syphilis, Prevalence, Sensitivity and Specificity, Mycoplasma, Kenya, Human, Male, diagnosis, therapy, ICA11

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ThB112