Can a two-glass urine test or leucocyte esterase test of first-void urine improve syndromic management of male urethritis in southern Thailand?

The goal of this study was to determine whether a urine two-glass test or a leucocyte esterase (LE) test of first-void urine (FVU) improve the sensiti vity or specificity of the World Health Organization (WHO) algorithm for th e syndromic management of men with urethritis in southern Thailand. A secon dary aim was to determine whether infection with Trichomonas vaginalis was sufficiently common to include treatment for it in a syndromic management p rotocol. One hundred and twenty-nine men with symptoms of urethritis seen a t 2 STD clinics in Songkla Province, Thailand were enrolled. Symptoms and s igns of each man were recorded and a urethral swab collected for microscopy and culture for Neisseria gonorrhoeae. A two-glass urine test and an LE te st of an FVU specimen were performed. The EW was tested by polymerase chain reaction (PCR) for N. gonorrhoeae, Chlamydia trachomatis and T, vaginalis. Dysuria was a symptom in 78% of men. A urethral discharge was a symptom in 68% but was evident on examination in 95% of the men. The prevalences of i nfection were 32.6% for N. gonorrhoeae, 23.3% for C. trachomatis, 1.6% for T. vaginalis and 51.9% for any infection. The sensitivities and specificiti es of urethral discharge on examination, two-glass test and LE test of FVU as indicators of infection with either or both of N. gonorrhoeae or C, trac homatis were 97% and 8%; 57% and 83%; and 59% and 78% respectively. Combina tions of urethral discharge on examination and one of the other indicators were more specific but much less sensitive than the presence of discharge a lone. Culture for N. gonorrhoeae was found to be only 43% sensitive compare d with an expanded gold standard involving a PCR test. Our analysis demonst rates that neither the two-glass test nor the LE test of FVU were useful in improving on the WHO algorithm for management of men with urethritis. T. v aginalis was not common enough to include in a first-line syndromic managem ent protocol for male urethritis. We recommend that, in southern Thailand, men with symptoms of urethritis in whom a urethral discharge is present on examination be offered immediate treatment for both N. gonorrhoeae and C, t rachomatis as per the WHO algorithm.