Title : A new insight in the clinical profile of Indian patients of urethritis and cervicitis with the help of molecular characterization of the causative organisms
Abstract:
Introduction: Urethritis and cervicitis, in the majority of cases, are caused by sexually transmitted agents. They presents as discharge, pain, burning sensation but sometimes the patient may remain asymptomatic. Neisseria gonorrhoeae (Gono-coccal) and chlamydia trachomatis (Non-gonococcal) are considered classical causative organisms of urethritis and cervicitis in developed and developing world respectively. Other causes are Mycoplasma genitalium, Ureaplasma Urealyticum, Trichomonas vaginalis and Herpes simplex etc. Number of newly diagnosed urethritis and cervicitis cases are increasing worldwide leading to many complications like prostatitis, epididymitis, pelvic inflammatory disease and infertility. Non-gonococcal urethritis and cervicitis cases are difficult to diagnose because of minimal visible discharge. Treatment is done with empirical antibiotics when the causative organism cannot be isolated. So basically urethritis and cervicitis are difficult to diagnose and treat which may lead to significant morbidity specially in the developing countries.
Objectives: To study the profile of patients presenting with symptoms of urethritis and cervicitis and to elucidate the various etiologic agents.
Methodology: Patients within 15 -45 years (both sexes) with history of urethral or cervical discharge, dysuria and dyspareunia were included in the study. Urethral or cervical samples were collected with the help of dacron swabs for multiplex real time polymerase chain reaction analysis of Neisseria Gonorrhoeae, Chlamydia Trachomatis, Mycoplasma Hominis & Ureaplasma Urealyticum.(TRUPCR? STD Panel kit 3B BlackBio Biotech India Ltd.
Results: A total of 70 patients were included and analyzed. Analysis was done using the SPSS version 21 for Windows (Chicago, Illinois, USA). Out of 70 patients, 64.3 % were female and 35.7% were male. Around 59% patients were in the age group of 18-30. Around 15.7 % had history of multiple sexual partners. PCR showed positivity for Ureaplasma urealyticum in 37.7%, Neisseria gonorrhoea in 15.9%, Chlamydia trachomatis in 10.1 %, Trichomonas vaginalis in 5.8 % cases. Rest of the samples showed mixed growth of multiple organism including Gardnerella Vaginalis and HSV 2
Discussion: Prevalence of urethritis/cervicitis is increasing worldwide and it varies around the globe. Especially the drug resistance strains of various gono-coccal and non-gonococcal pathogens are growing. Empirical treatment without knowing the exact pathogen can lead to persistent infection and complications. NAAT and species specific PCR test are recommended to decide etiology based treatment. We found Ureaplasma urealyticum as the major pathogen causing urethritis and cervicitis. This is in contrast to western data where we see chlamydia as the major pathogen Though initially considered as commensal, Ureaplasma urealyticum is considered a significant pathogen causing persistent urethritis and cervicitis after 1950 AD. This is in contrast to western data where we see chlamydia as the major pathogen. Significant numbers (40%) had mixed infections also. So we wish to emphasize the role of PCR and etiology based regimen in the management of urethritis and cervicitis
