Urethral infection in a workplace population of East African men: evaluation of strategies for screening and management.
Transport workers (n = 504) in Mombasa, Kenya, were screened for urethral infection by history, clinical examination, and laboratory testing of urethral swabs and first-catch urine specimens. The prevalence of Neisseria gonorrhoeae was 3.4%, Chlamydia trachomatis, 3.6%, and Trichomonas vaginalis, 6.0%; more than two-thirds of infections were asymptomatic. A complaint of urethral discharge, dysuria, or both was twice as sensitive as the sign of discharge on physical examination (34.5% vs. 15.5%) in identifying infection. A positive leukocyte esterase dipstick (LED) test on urine predicted infection with a sensitivity of 95.0% and a specificity of 59.3% in symptomatic men and with a sensitivity of 55.3% and a specificity of 82.8% in asymptomatic men. Demographic and behavioral factors were not independent predictors of infection. In resource-poor settings with high prevalences of urethral infection, an effective screening and management strategy would be to treat symptomatic men, as well as asymptomatic men with a positive LED test, for all three infections.
Jackson
D J
DJ
Department of Medical Microbiology, University of Nairobi, Kenya.
Rakwar
J P
JP
Chohan
B
B
Mandaliya
K
K
Bwayo
J J
JJ
Ndinya-Achola
J O
JO
Nagelkerke
N J
NJ
Kreiss
J K
JK
Moses
S
S
D000293:Adolescent; D000328:Adult; D000349:Africa / Q000453:epidemiology; D001424:Bacterial Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D002690:Chlamydia Infections / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D005260:Female; D006069:Gonorrhea / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D014247:Trichomonas Vaginitis / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D014522:Urethral Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D017132:Workplace