Mixed urethral infection in patients with urethral discharge in the southern region of Kuwait

Abdel-Hamid F El-Gamal; Sultan RS Al-Otaibi; Abdullah Alshamali; Adel Abdulrazzaq; Nabeel Najem; Abdulwahab Al Fouzan

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ORIGINAL ARTICLE

Year : 2008 \| Volume : 29 \| Issue : 1 \| Page : 29-31

Mixed urethral infection in patients with urethral discharge in the southern region of Kuwait

Abdel-Hamid F El-Gamal¹, Sultan RS Al-Otaibi¹, Abdullah Alshamali², Adel Abdulrazzaq¹, Nabeel Najem¹, Abdulwahab Al Fouzan¹
¹ Department of Dermatology, Adan Hospital, State of Kuwait, Kuwait
² Department of Microbiology, Adan Hospital, State of Kuwait, Kuwait

Correspondence Address:
Sultan RS Al-Otaibi
P. O. Box: 2193, Al-Qurain 47372
Kuwait

Source of Support: None, Conflict of Interest: None

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Abstract

Although chlamydial and gonorrheal urethritis are the most prevalent sexually transmitted diseases, the frequency of the co-occurrence of both the diseases is still not well established. The aim of this study was to determine the frequency of the co-occurrence of the two diseases in the southern region of Kuwait State among men with a past history of heterosexual intercourse who sought medical care for urethral discharge. Over a period from October 2005 till October 2006, a total of 475 patients were selected for the study from among the patients attending the OPD clinics of Al-Adan Hospital for treatment of sexually transmitted diseases. The subjects were screened for both gonorrhea and chlamydia with polymerase chain reaction and Gram's stain, using specimens from the urethral discharge. Out of the total of 475 patients, 125 (26.3%) had gonorrhea, 47 (9.8%) had chlamydia, and 11 (7.31%) had both diseases. We concluded that co-occurrence of chlamydia and gonorrhea may be common among males presenting with urethral discharge.

Keywords: Gonorrhea, chlamydia

How to cite this article:
El-Gamal AHF, Al-Otaibi SR, Alshamali A, Abdulrazzaq A, Najem N, Al Fouzan A. Mixed urethral infection in patients with urethral discharge in the southern region of Kuwait. Indian J Sex Transm Dis 2008;29:29-31

How to cite this URL:
El-Gamal AHF, Al-Otaibi SR, Alshamali A, Abdulrazzaq A, Najem N, Al Fouzan A. Mixed urethral infection in patients with urethral discharge in the southern region of Kuwait. Indian J Sex Transm Dis [serial online] 2008 [cited 2023 Dec 10];29:29-31. Available from: https://ijstd.org/text.asp?2008/29/1/29/42712

Introduction

Chlamydial urethritis and gonorrhea are the leading reportable sexually transmitted diseases in the United States. In the UK, gonorrhea is considered the second most common bacterial sexually transmitted infection. In France, the average number of cases of Neisseria ^{More Details} gonorrhea isolated per laboratory per year decreased from 10.6 in 1986 to 0.6 in 1997 but then increased yearly to reach 1.9 in 2000. Gonococcal and nongonococcal urethritis have been the most commonly reported sexually transmitted diseases in China since the reemergence of STDs in the late 1970s and early 1980s.^[5]

In another study Among individuals infected with gonorrhea, 3.3-37% were concurrently infected with Chlamydia, and 12-28% of men infected with chlamydia were concurrently infected with gonorrhea. Although gonorrhea and chlamydial infections can be easily diagnosed and treated, the undetected and untreated infections can lead to severe health problems such as pelvic inflammatory disease (PID), ectopic pregnancy, and infertility in females and testicular and prostate infections and infertility in males.^[8]

In Kuwait, data on the incidence of gonorrhea and chlamydial infections is limited and often missing. Our aim was to determine the co-occurrence of the two diseases among men with urethral discharge attending STD clinics in southern Kuwait.

Materials and Methods

This study was conducted in the STD clinics of Al-Adan hospital, which is the referral center for the whole southern region of the State of Kuwait. Men attending the STD clinics, with a history of heterosexual intercourse and with complaints of urethral discharge (which was confirmed by clinical examination and, if necessary, by milking the urethra), were included in this study. After a thorough physical examination, two urethral swab samples were taken. The swab was inserted 1-2 cm into the urethra and rotated for 30 s before being withdrawn. One sample was smeared on a slide and examined with Gram's stain and the other was stored at −200°C to be tested later for N. gonorrhea and C. trachomatis by polymerase chain reaction (PCR) assay.

Results

From October 2005 to October 2006, a total of 475 newly registered male patients complaining of urethral discharge, and with a past history of heterosexual intercourse, were included in this study. The mean age of the patients was 32.5 years (standard deviation 7.62 years; range: 17-61 years). Out of the 475 patients, 125 (26.3%) had gonococcal urethritis, 47 (9.8%) had chlamydial urethritis, and 11 (2.31%) were diagnosed as having coinfection with both N. gonorrhea and C. trachomatis [Table 1]. Coinfection with C. trachomatis was seen in 11/136 (8.09%) patients with gonococcal urethritis, whereas coinfection with N. gonorrhea was seen in 11/58 (18.97%) patients with chlamydial urethritis [Table 2].

[Table 3] shows the agreement between the results of Gram's stain and PCR in the diagnosis of gonorrhea. They agree in 134 (98.52%) of the 136 cases of gonorrhea and disagree in 2 cases (1.48%) only. The overall correlation between the two methods was (99.4%).

Discussion

Consistent with previous studies, we found high proportions of individuals who had coinfection with both organisms.^[6]

Contrary to almost all studies that reported coinfection rates in both directions,^{[7],[9],[10],[11],[12]} the chlamydial coinfection rate among individuals having gonorrhea was lower than the gonorrhea coinfection among individuals infected with chlamydia. We screened health care-seeking patients using nucleic acid amplification tests (NAATs) to detect both diseases in one laboratory sample besides doing a Gram's stain in another sample. Our findings may differ from those of previous studies because of differences in the methodology used for disease detection and sampling. Creighton et al. ,^[7] Lyss et al. ,^[9] and Hijazi et al. [12] utilized culture and nonamplification methods to detect both diseases; these techniques have been found to be less sensitive than NAATs.^[13] Some studies have shown that a higher or lower overall prevalence for gonorrhea and chlamydial infection do not necessarily translate into corresponding higher or lower prevalence of coinfection among those carrying either STD.^[9],[14] The sensitivity of Gram's stain for the diagnosis of gonococcal urethritis in symptomatic males was found to range from 89-95%, whereas the specificity has been reported to be between 94-97%.^{[15],[16],[17]} Consistent with our results, Juchau et al. [18] concluded that the agreement between PCR and Gram's stain examination in the diagnosis of gonorrhea was 99.6%; since PCR is far more expensive, we felt that there was no practical reason to prefer it over Gram's stain for the diagnosis of gonorrhea in symptomatic males.

One limitation of our study is that it is not possible to generalize our findings to other geographic locations or other high-risk populations; we conducted our study on a small group of patients and the area where we conducted the study has only about 1/6^th of the total population of Kuwait state. We recommend that simultaneous screening for both chlamydia and gonorrhea should remain the first line of intervention. Also, more generalized studies, including subjects from all over Kuwait state, need to be conducted.

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