Etiology of urethral discharge in West Africa: the role of Mycoplasma genitalium and Trichamonas vaginalis

Objective To determine the etiological role of pathogens other than Neisser ia gonorrhoeae and Chlamydia trachomatis in urethral discharge in West Afri can men. Methods Urethral swabs were obtained from 659 male patients presenting with urethral discharge in 72 primary health care facilities in seven West Afri can countries, and in 339 controls presenting for complaints unrelated to t he genitourinary tract. Polymerase chain reaction analysis was used to dete ct the presence of N. gonorrhoeae, C. trachomatis, Trichomonas vaginalis, M ycoplasma genitalium, and Ureaplasma urealyticum. Findings N. gonorrhoeae, T; vaginalis, C. trachomatis, and M. genitalium - but not U. urealyticum - were found more frequently in men with urethral di scharge than in asymptomatic controls, being present in 61.9%, 13.8%, 13.4% and 10.0%, respectively, of cases of urethral discharge. Multiple infectio ns were common. Among patients with gonococcal infection, T: vaginalis as f requent a coinfection as C. trachomatis. M. genitalium, T vaginalis,and C. trachomatis caused a similar clinical syndrome to that associated with gono coccal infection, but With a less severe urethral discharge. Conclusions M. genitalium and T. vaginalis are important etiological agents of urethral discharge in West Africa. The frequent occurrence of multiple infections with any combination of four pathogens strongly supports the syn dromic approach. The optimal use of metronidazole in flowcharts for the syn dromic management of urethral discharge needs to be explored in therapeutic trials.