Co-infection with Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis in symptomatic South African men with urethritis: implications for syndromic management.

Background: This study was undertaken to determine co-infection rates of common aetiological agents of ure- thritis and information regarding sexual contacts of symptomatic males presenting to a family practitioner. Methods: Endo-urethral swab specimens were collected from 253 symptomatic men and tested for N. gonorrhoeae, C. trachomatis by the BD ProbeTec ™ ET assay and for T. vaginalis by real-time PCR. Information regarding sexual behav- iour was collected by the practitioner using a structured interview. Results: Of the 253 patients investigated, 50 complained of urethral discharge with/without burning on micturition (BOM), the remaining 203 only complained of BOM. N. gonorrhoeae was isolated from 45%, C. trachomatis from 15% and T. vaginalis from 5.5%. N. gonorrhoeae/C. trachomatis co-infection was diagnosed in 7.5% and T. vaginalis was de- tected in a higher number of males presenting without visible discharge. Similar number of men reported sexual contact only with their wives compared to men having casual sexual contacts. There were fewer gonococcal infections in men re- porting sexual contact with their wives alone compared to men reporting casual sexual encounters. Conclusions: Treatment guidelines for men presenting to Primary Health Care facilities and Family Practitioners need to consider the evolving antimicrobial resistance profiles and the presence of mixed infections in symptomatic patients.