Idiopathic Urethritis in Young Men in the United States: Prevalence and Comparison to Infections with Known Sexually Transmitted Pathogens
Received 14 February 2009; accepted 30 June 2009. published online 03 September 2009.
Abstract
Purpose
Urethritis is the most common male reproductive tract disease syndrome; yet 20–50% of diagnosed cases have no defined etiology, and few population-level data exist on the prevalence or etiology of the syndrome. We estimated the prevalence of urethritis among young men in the United States and compared correlates of idiopathic cases to correlates of detected infections with sexually transmitted pathogens.
Methods
Questionnaire data and urine specimens from 5,447 men aged 18–27 years participating in Wave III of the National Longitudinal Study of Adolescent Health were analyzed. Symptomatic urethritis was defined as self-reported dysuria or urethral discharge in the past 24hours. Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, and Mycoplasma genitalium were identified using nucleic acid amplification tests. Idiopathic urethritis (IU) was defined as urethral symptoms in the absence of these four pathogens. Stratified weighted analyses generated population-based estimates.
Results
Urethritis was reported by 1.2% (95% CI=.8–1.6%) of men, of whom 82.4% (61.1–93.3%) had IU. Men with previous STD diagnoses (aOR=9.3 [95% CI=3.0–28.7]), or fewer (1–4) or no lifetime vaginal sex partners (aOR=7.5 [2.9–19.3] and aOR=7.2 [1.9–27.4]), were more likely to have IU compared with men without urethral symptoms or identified pathogens, whereas men of Native American or Asian/Pacific Islander descent (aOR=.04 [.01–.2]) and heavy drinkers (aOR=.08 [.03–.2]) were less likely to have IU. Unlike infection with known pathogens, IU was not associated with black race, Hispanic ethnicity, or age at sexual debut.
Conclusions
Urethral symptoms were rarely associated with known pathogens. IU and known pathogens were associated with distinct characteristics.
aDepartment of Epidemiology, University of Washington, Seattle, Washington
bDepartment of Medicine, University of Washington, Seattle, Washington
cCenter for AIDS and STD, University of Washington, Seattle, Washington
Address correspondence to: Lisa E. Manhart, Ph.D., University of Washington Center for AIDS and STD, Harborview Medical Center, Box 359931, 325 9th Avenue, Seattle, WA 98104-2499.
This work was presented in part at the 17th Biennial Meeting of the International Society for Sexually Transmitted Diseases Research (ISSTDR), Seattle, WA, July 29 to August 1, 2007 (Abstract #O-035).
ABSTRACT