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Chlamydial infection in female partners of male patients diagnosed with asymptomatic non-gonococcal urethritis

Sir: We read with interest the article by Manavi et al. as regards genital infection in male partners of women with chlamydial infection. In particular, we note the finding that eight out of 83 (10%) uninfected male partners had urethral symptoms, implying 75 had no symptoms. The authors did not stipulate whether these 75 patients had evidence of urethritis from a urethral smear or from microscopy of threads on a first voided urine. This in fact, was a basis of a retrospective study that we undertook. The study focused in particular on the diagnosis of chlamydia in female partners of patients diagnosed with asymptomatic non-gonococcal urethritis, who were found, subsequently, not to have genital chlamydial infection. Case notes of male patients diagnosed with nongonococcal urethritis (NGU) were retrospectively analysed in 2003 using KC60 data; the time period for analysis was approximately in the last six months of the year. Case notes were then analysed for asymptomatic presentation (as defined by absence of urinary symptoms, history of discharge, urethral or testicular discomfort) and as to whether the sexual contacts were diagnosed with genital chlamydia. Information regarding partner notification was obtained from both a standard ‘contacttracing sheet’ in all notes and a cross-reference insert, which is routinely completed if an index patient refers to a known patient as a reason for attendance. Chlamydia was diagnosed from a first voided urine sample using a standard Becton Dickinson Probtec strand displacement assay. NGU was diagnosed where five or more polymorphonuclear leucocytes (PMNLs) were recorded per high power field on Gram stain of the urethral smear or 10 or more PMNLs on microscopy of threads on the first voided urine – both averaged over five fields. Patients were asked not to void urine for at least two hours prior to their appointment. Fifty case notes were analysed in total, 17 patients with NGU being asymptomatic. Seven female contacts of this asymptomatic cohort attended. Fifty seven percent of contacts that attended (4/7) were diagnosed with genital chlamydia. In other words 24% (four out of a minimum of 17 contacts of male patients with asymptomatic NGU) were diagnosed with chlamydia. Manavi’s study focused on the prevalence of infection in male contacts of women with chlamydia. Conversely, our study looked at the prevalence of chlamydia in female partners of males diagnosed with asymptomatic NGU who subsequently were found to be chlamydia negative. If these asymptomatic males did not have a urethral smear, it is possible that a proportion of the 24% of their female partners with chlamydia would have been missed. Furthermore, as only seven of the 17 female contacts were seen, the proportion of those diagnosed with chlamydia may have been higher if more had attended. We would, therefore, advocate caution in abandoning routine screening for urethritis in asymptomatic male patients.