Idiopathic Urethritis in Young Men in the United States: Prevalence and Comparison to Infections with Known Sexually Transmitted Pathogens

Purpose: Urethritis is the most common male reproductive tract disease syndrome; yet 20-50% of diagnosed cases have no defined etiology, and few population-level data exist on the prevalence or etiology of the syndrome. We estimated the prevalence of urethritis among young men in the United States and compared correlates of idiopathic cases to correlates of detected infections with sexually transmitted pathogens. Methods: Questionnaire data and urine specimens from 5,447 men aged 18-27 years participating in Wave III of the National Longitudinal Study of Adolescent Health were analyzed. Symptomatic urethritis was defined as self-reported dysuria or urethral discharge in the past 24 hours. Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, and Mycoplasma genitalium were identified using nucleic acid amplification tests. Idiopathic urethritis (IU) was defined as urethral symptoms in the absence of these four pathogens. Stratified weighted analyses generated population-based estimates. Results: Urethritis was reported by 1.2% (95% CI =.8-1.6%) of men, of whom 82.4% (61.1-93.3%) had IU. Men with previous STD diagnoses (aOR = 9.3 [95% CI = 3.0-28.7]), or fewer (1-4) or no lifetime vaginal sex partners (aOR = 7.5 [2.9-19.3] and aOR = 7.2 [1.9-27.4]), were more likely to have IU compared with men without urethral symptoms or identified pathogens, whereas men of Native American or Asian/Pacific Islander descent (aOR =.04 [.01-.2]) and heavy drinkers (aOR =.08 [.03-.2]) were less likely to have IU. Unlike infection with known pathogens, IU was not associated with black race, Hispanic ethnicity, or age at sexual debut. Conclusions: Urethral symptoms were rarely associated with known pathogens. IU and known pathogens were associated with distinct characteristics. (C) 2009 Society for Adolescent Medicine. All rights reserved.