Aetiology of urethral discharge in Bangui, Central African Republic

Objectives: To determine the aetiology of urethritis in Bangui, Central Afr ican Republic. Methods: 410 men presenting with urethral discharge and 100 asymptomatic co ntrols were enrolled. Urethral swabs were obtained and processed by gonococ cal culture and polymerase chain reaction for the detection of Neisseria go norrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, Trichomonas vagina lis, and Ureaplasma urealyticum. Results: In multivariate analyses, M genitalium and C trachomatis were sign ificantly associated with urethral discharge when comparing cases of non-go nococcal urethritis (NGU) with controls. T vaginalis was also more common i n cases than in controls, but this reached statistical significance only am ong cases in whom N gonorrhoeae was also detected. U urealyticum was not as sociated with urethritis. The gonococcus was found in 69% of cases of ureth ral discharge. M genitalium was the predominant pathogen in patients with N GU, being found in 42% (53/127) of such patients while C trachomatis was fo und in only 17% (22/127). T vaginalis was found in 18% (23/127) of patients with NGU, but also in 15% (43/283) of patients with gonococcal urethritis, and two thirds of patients with T vaginalis also had the gonococcus. Multi ple infections were common. M genitalium caused a syndrome similar to chlam ydial urethritis, with a less severe inflammation than in gonococcal infect ion. No behavioural or clinical characteristic could discriminate between t he various aetiological agents. Conclusions: M genitalium is more prevalent than C trachomatis and is the m ost common cause of NGU in Bangui. It causes a syndrome similar to chlamydi al urethritis. T vaginalis is weakly associated with urethritis, and is oft en found along with other pathogens.