Incidence of Nongonococcal Urethritis in Men Who Have Sex With Women and Associated Risk Factors. Issue 5 (May 2021)

• Record Type: Journal Article
• Authors: Rowlinson, Emily; Hughes, James P.; Chambers, Laura C.; Lowens, M. Sylvan; Morgan, Jennifer L.; Robinson, Tashina S.; Romano, Sarah S.; Leipertz, Gina L.; Soge, Olusegun O.; Golden, Matthew R.; Manhart, Lisa E.
• Is Part Of: Sexually transmitted diseases. Volume 48:Issue 5(2021)
• Publication Date: 2021-05
• Subjects: Sexually transmitted diseases -- Periodicals; Sexual health -- Periodicals; 616.951005
• DOI: 10.1097/OLQ.0000000000001314
• Languages: English
• ISSNs: 0148-5717

Abstract

Abstract : Background: Incidence and risk factors for nongonococcal urethritis (NGU) remain poorly defined. We conducted a cohort study to estimate the incidence of NGU and identify risk factors in men who have sex with women. Methods: We enrolled cisgender male sexually transmitted disease clinic attendees 16 years or older who reported exclusively female partners. At enrollment and 6 monthly follow-up visits, men underwent a clinical examination, provided urethral swab and urine specimens, completed a sexual behavior survey and biweekly diaries, and were tested for Chlamydia trachomatis (CT) and Mycoplasma genitalium (MG) using Aptima assays (Hologic, Inc). Nongonococcal urethritis was defined as ≥5 polymorphonuclear leukocytes per high-power field plus either urethral symptoms or visible discharge. We estimated the incidence of NGU overall, asymptomatic and symptomatic NGU, non-CT/non-MG NGU, and CT/MG-associated NGU using Poisson regression for clustered outcomes. We performed relative risk binomial regression for clustered data to identify characteristics associated with incident NGU. Results: From August 2014 to July 2018, 307 participants at risk for NGU contributed 109.4 person-years. Median age was 32 years, and 52% were White. At enrollment, 107 men had NGU; of these, 88% were symptomatic, 27% had CT, and 22% had MG. Fifty men had 60 cases of incident NGU (incidence rate, 56 per 100 person-years; 95% confidence interval, 43–74). Unlike prevalent NGU at enrollment, CT/MG-associated incident NGU was rare (incidence rate, 7; 95% confidence interval [CI], 4–15), and most (78%) incident NGU was asymptomatic. Risk factors for incident NGU were ⩽ high school education (adjusted rate ratio [ARR], 2.45; 95% CI, 1.19–5.00), history of CT (ARR, 2.15; 95% CI, 1.08–4.27), history of NGU (ARR, 2.67; 95% CI, 1.27–5.62), and NGU at enrollment (ARR, 2.03; 95% CI, 1.04–3.98). Neither condom use nor having a new partner was associated with incident NGU; Black race was only associated with incident symptomatic and non-CT/non-MG NGU. Conclusions: Incidence of NGU was high, predominantly non-CT/non-MG and asymptomatic. Future studies should investigate the etiology and clinical significance of asymptomatic NGU. Abstract : In a cohort of cisgender men who have sex with women, we found a high incidence of nongonococcal urethritis, which was predominantly non– Chlamydia trachomatis /non– Mycoplasma genitalium, asymptomatic, and not associated with traditional sexually transmitted infection risk factors.Supplemental digital content is available in the text.