2715
Views & Citations1715
Likes & Shares
Background: Gonococcal
urethritis is of global concern and particularly in Sub-Saharan Africa where
sexually transmitted infections (STIs) are a public health problem.
Case: A 32 year old male
consulted for dysuria and purulent urethral discharge following sexual
intercourse with an occasional partner. The biological work-up revealed nothing
but Neisseria gonorrhoeae. He
received a single intramuscular dose of ceftriaxone 250 mg which was followed
by a good clinical response.
Conclusion: We recommend
health policy makers to intensify primary prevention, subsidise the use of
multiplex polymerase chain reaction testing for Neisseria gonorrhoeae, Chlamydia
trachomatis, Mycoplasma hominis, Ureaplasma urealyticum and Trichomonas vaginalis, for the
management of cases of purulent gonococcal urethritis and for screening in
asymptomatic cases.
Keywords: Urethral discharge, Gonococcal urethritis, Neisseria gonorrhoeae, Sexually
transmitted infections
INTRODUCTION
By presenting this clinical case
in our environment where hepatitis B infections, hepatitis C, HIV are public
health problems, and where co-infections are common [4], we would like to draw
the attention of practitioners and health policy makers to the need to respect
the current protocol for the management of purulent gonococcal urethritis,
taking into account the existence of asymptomatic cases [5].
CASE
This is a 32 year old patient,
who had consulted for dysuria and purulent urethral discharge occurred 3 days
after having sex with an occasional partner (Figure 2). Direct examination
of pus in
the bacteriology laboratory
of the
DISCUSSION
Gonococcal
urethritis is part of the STIs that currently constitute a public health
problem, despite the means taken for many decades now in primary prevention and
curative treatment especially in our setting where self-medication, roadside
drugs and antibiotic resistances remain challenges to be met [6,7]. The other
challenges in sub-Saharan setting are that of inadequate treatment by native
doctors, wrong information concerning the disease from some media, low level of
education mainly in remote areas and in some pouch of the population living in
town
The case we are
presenting is that of the typical presentation of an acute urethritis caused by
NG, whose management respects the current recommendations on purulent
urethritis, that is; biological confirmation of the diagnosis, the search for
potential co-infections, the management of sexual partner or partners, the
choice of an effective antibiotic, administered at appropriate doses and which
is not subjected to resistances and the consideration of the pandemic
background of HIV and HBV infections. However, there exist cases of
asymptomatic gonococcal urethritis which are not treated, thus exposing to
infertility and contamination of sexual partners not only by NG, but by other
potential bacteria (Chlamydia trachomatis, Mycoplasma hominis, Ureaplasma
urealyticum, Mycoplasma genitalium), parasite (Trichomonas
vaginalis) and viruses (VIH, VHB) in case of co-infection [8,9]. These,
together with antibiotic resistances put in question the syndromic treatment of
gonococcal urethritis [6,10,11]. If it is true that this patient had enough
financial power to take on himself the cost of his treatment, 180 US Dollars,
it is not always the case in our setting where the purchasing power of the
population is low (guaranteed minimum wage=66 US Dollars) and where social
security is nearly absent.
Apart from
Chlamydia which we searched by PCR, identification of NG was done by culture,
that of Mycoplasma by the Mycofast* technique and Trichomonas vaginalis
by direct examination. Whereas in our setting, the popularization of the PCR
for biological diagnosis of not only NG but of other germs causing urethral
discharge and even potential co-infections, could contribute in improving the
diagnosis and management of symptomatic and asymptomatic gonococcal urethritis,
as well as fighting against resistances.
CONCLUSION
In addition to
intensifying current sensitization strategies of populations at risk of STIs,
the state should bear the cost of the current treatment protocols for gonococcal
urethritis in our setting and popularize the multiplex polymerase chain
reaction testing for NG, Chlamydia trachomatis, Mycoplasma hominis,
Mycoplasma genitalium, Ureaplasma urealyticum and Trichomonas
vaginalis, especially in the management of acute cases and screening of
asymptomatic gonococcal urethritis.
DECLARATIONS
Ethics approval and consent to participate
Ethical approval
was obtained from Douala General Hospital for publication of this case report.
Consent for publication
Written informed
consent was obtained from the patients for publication of this case report and
any accompanying images. A copy of the written consent is available for review
by the Editor-in-Chief of this journal.
Availability of data and material
The datasets
(medical file of the patient) is available in Douala General Hospital on
reasonable request.
Competing interests
“The authors
declare that they have no competing interests” in this section.
Funding
None.
Author’s contributions
All authors
participated in the design and editing of the manuscript, all authors approved
the final version of the manuscript.
Acknowledgement
We express our
sincere gratitude to all doctors, biologists, nurses and medical students who
took part in the management of the patient.
1.
World Health Organization
(2012) Global incidence and prevalence of selected curable sexually transmitted
infections - 2008. WHO.
2.
Chico RM, Mayaud P, Ariti
C, Mabey D, Ronsmans C, et al. (2012) Prevalence of malaria and sexually
transmitted and reproductive tract infections in pregnancy in sub-Saharan
Africa: A systematic review. JAMA 307: 2079-2086.
3.
National Institute of
Statistics and ICF International (2012) Demographic and Health Survey and
Multiple Indicators of Cameroon 2011. Calverton, Maryland: INS and ICF
International.
4.
Nana Njamen T, Tchente
Nguefack C, Njamen Nana C, Ntolefack Nkemtendong P, Okalla C, et al. (2017)
Pathogenic profile of female patients with genital tract infections in a
tertiary hospital in sub-Saharan Africa’s setting. Afr J Integr Health 7:
42-48.
5.
CDC (2014) Sexually
transmitted diseases treatment guidelines. MMWR 59: 36-38, 103-108.
6.
Nana Njamen T, Njamen
Nana C, Nkwabong E, TchenteNguefack C, Nsagha DS, et al. (2017) Is there still
a place for symptomatic treatment in the management of sexually transmitted
infections in low resource setting? Afr J Integr Health 7: 17-21.
7.
Ministère de la santé
publique (MSP) (2007) Rapport d’évaluation de la qualité de soins fournis aux
malades consultant pour Infections Sexuellement Transmissibles dans les
formations sanitaires du Cameroun. Calverton, Maryland: MSP infection.
8.
Ong JJ, Fethers K, Howden
BP, Fairley CK, Chow EPF, et al. (2017) Asymptomatic and symptomatic urethral
gonorrhoea in men who have sex with men attending a sexual health service. Clin
Microbiol Infect 23: 555-559.
9.
Rietmeijer CA, Mungati M,
Machiha A, Mugurungi O, Kupara V, et al. (2018) The etiology of male urethral
discharge in Zimbabwe: Results from the Zimbabwe STI etiology study. Sex Transm
Dis 45: 56-60.
10.
Judson FN (1986)
Treatment of uncomplicated gonorrhea with ceftriaxone: A review. Sex Transm Dis
13: 199-202.
11.
Menezes Filho JR,
Sardinha JCG, Galban E, Saraceni V, Talhari C (2017) Effectiveness of syndromic
management for male patient with urethral discharge symptoms in Amazonas,
Brazil. An Bras Dermatol 92: 779-784.
QUICK LINKS
- SUBMIT MANUSCRIPT
- RECOMMEND THE JOURNAL
-
SUBSCRIBE FOR ALERTS
RELATED JOURNALS
- Journal of Blood Transfusions and Diseases (ISSN:2641-4023)
- Journal of Cancer Science and Treatment (ISSN:2641-7472)
- Journal of Carcinogenesis and Mutagenesis Research (ISSN: 2643-0541)
- Chemotherapy Research Journal (ISSN:2642-0236)
- Advance Research on Alzheimers and Parkinsons Disease
- BioMed Research Journal (ISSN:2578-8892)
- Journal of Pathology and Toxicology Research