SPECIFICITY OF DYSURIA AND DISCHARGE COMPLAINTS AND PRESENCE OF URETHRITIS IN MALE-PATIENTS ATTENDING AN STD CLINIC IN MALAWI

Objective: This study evaluated the specificity of discharge and dysur ia for laboratory confirmed urethritis in symptomatic men presenting t o an urban STD clinic in Malawi for treatment and returning for follow up evaluation. Methods: Clinical treatment trial where consecutive co nsenting men with urethritis were enrolled and administered a question naire, examined, tested, and given one of five urethritis treatments w ith an efficacy range of 33-95%. Men returning for follow up were ques tioned, examined, and tested. Results: The presence of both discharge and dysuria were highly specific for laboratory confirmed urethritis ( over 90%). Compared with men who had complaints of both discharge and dysuria, men with complaints of dysuria alone were mon likely to have reported Frier treatment, 72% v 48% (p = 0.003), and less likely to ha ve had gonorrhoea, 64% v 83% (p = 0.04). Men with complaints of discha rge or dysuria without evidence of discharge were rare but half of the m had documented urethritis. Among men who returned for follow up, 72% had no symptoms of either discharge or dysuria. However, among the 23 8 men with no symptoms at follow up, laboratory documented gonorrhoea occurred in 9% and non-gonococcal urethritis in 21%. Discussion: In th is population of men discharge or dysuria were specific symptoms for u rethritis. The symptom of dysuria should be added as an entry criterio n for evaluation for urethritis in the World Health Organisation's tre atment recommendations. The high prevalence of asymptomatic infection at follow up in a population of men who received suboptimal antimicrob ial therapy suggests that the most effective therapy available should be given at the first visit.