Azithromycin in non-gonococcal urethritis.

The efficacy and safety of a single 1 g oral dose of azithromycin was evaluated in 100 male patients with non-gonococcal urethritis (NGU). Enrolled were men with > or = 5 polymorphonuclear leukocytes (PMNL)/high power field (HPF) (x 1000 magnification) in a Gram-stained smear of urethral discharge with or without symptoms and signs of NGU. Of the 66 evaluable patients, Chlamydia trachomatis was isolated from 18 cases (27.3%) and Ureaplasma urealyticum from 12 cases (18.2%). After treatment, signs and symptoms disappeared from 59 cases (89.4%). Forty-four cases (66.7%) showed reduced PMNL/HPF. C. trachomatis was eradicated in 18 cases (100%) and U. urealyticum in 12 cases (83.3%). One patient complained of mild dizziness, moderate nausea, and palpitations. Single 1 g oral dose of azithromycin appears to be effective and safe for treating chlamydial, non-chlamydial, and ureaplasmal NGU. In addition, its ease of use encourages patient compliance.

Etiology of urethritis in Thai men.

The etiology of urethritis was determined for 303 Thai men with urethral discharge containing 5 or more polymorphonuclear cells (PMN)/high power field (hpf) and 132 men with a discharge containing less than 5 PMN/hpf. Neisseria gonorrhoeae was isolated significantly more often from men with greater than or equal to 5 PMN/hpf than from men with less than 5 PMN/hpf (42% vs 1%, P less than .0001). Chlamydia trachomatis was also isolated more often from patients with greater than or equal to 5 PMN/hpf than from men with less than 5 PMN/hpf (16% vs 8%, P less than .03). Ureaplasma urealyticum was isolated with nearly equal frequency from both groups of patients (45% vs 37%). Among men with a urethral exudate containing greater than or equal to 5 PMN/hpf, N. gonorrhoeae was isolated as the only pathogen from 19% and in combination with C. trachomatis or U. urealyticum in 23% of these men. C. trachomatis or U. urealyticum, but not N. gonorrhoeae, was isolated from 30%, and no pathogen was isolated from 28% of these men. Among men with urethral exudate containing less than 5 PMN/hpf, N. gonorrhoeae was isolated from only 1%, C. trachomatis or U. urealyticum from 41%, and no pathogen from 58%. These findings suggest that all Thai men with urethral discharge containing greater than or equal to 5 PMN/hpf should be treated for non-gonococcal urethritis and for gonococcal urethritis if gram-negative diplococci are demonstrated on gram stain of the urethral discharge. Men with urethritis with less than 5 PMN/hpf should be treated for only non-gonococcal urethritis.