{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T19:18:29Z","timestamp":1784920709971,"version":"3.55.0"},"reference-count":24,"publisher":"BMJ","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sex Transm Infect"],"accepted":{"date-parts":[[2012,1,10]]},"published-print":{"date-parts":[[2012,6]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Acute urethritis is among the most common types of sexually transmitted diseases in men. The diagnosis usually requires microscopic evidence of urethritis, but sometimes urethral pathogens are detected in asymptomatic men without such evidence. The aims of this study were to assess the sensitivity of Gram stain in men with urethral symptoms and to relate it to the microorganisms isolated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Between January 2006 and December 2007, 491 urethral samples were analysed. The authors assessed the presence of leukocytes by Gram stain and tested specifically for<jats:italic>Chlamydia<\/jats:italic><jats:italic>trachomatis<\/jats:italic>,<jats:italic>Ureaplasma urealyticum<\/jats:italic>,<jats:italic>Mycoplasma hominis<\/jats:italic>and<jats:italic>Trichomonas vaginalis<\/jats:italic>, as well as analysing the results of conventional culture.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The percentages of positive samples as a function of Gram category were two or less polymorphonuclear leukocytes (PMNLs)\/high-power field (HPF) 25% (92\/364), three to four PMNLs\/HPF 32% (18\/57) and five or more PMNLs\/HPF 54% (38\/70). Classing samples with more than two PMNLs\/HPF as positive, the sensitivity, specificity and positive likelihood ratio for Gram stain were 38% (95% CI 30 to 46), 79% (95% CI 75 to 84) and 1.8 (95% CI 1.4 to 2.4), respectively. On the other hand, taking as positive five or more PMNLs\/HPF, the sensitivity, specificity and positive likelihood ratio for Gram stain were 26% (95% CI 18 to 33), 91% (95% CI 87 to 94) and 2.7 (95% CI 1.8 to 4.2), respectively. The sensitivity of Gram stain to<jats:italic>Neisseria gonorrhoeae<\/jats:italic>,<jats:italic>Chlamydia trachomatis<\/jats:italic>and<jats:italic>Ureaplasma urealyticum<\/jats:italic>were 80% (95% CI 64 to 96), 23% (95% CI 8 to 39) and 11% (95% CI 2 to 20), respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The low sensitivity of Gram stain means that negative results do not exclude the presence of urethritis in symptomatic patients.<\/jats:p><\/jats:sec>","DOI":"10.1136\/sextrans-2011-050150","type":"journal-article","created":{"date-parts":[[2012,2,4]],"date-time":"2012-02-04T02:22:48Z","timestamp":1328322168000},"page":"284-287","source":"Crossref","is-referenced-by-count":23,"title":["Sensitivity of Gram stain in the diagnosis of urethritis in men"],"prefix":"10.1136","volume":"88","author":[{"given":"M\u00aa Angeles","family":"Orellana","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00aa Luisa","family":"G\u00f3mez-Lus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Lora","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2012,2,2]]},"reference":[{"key":"2024051320474913000_88.4.284.1","unstructured":"Perea EJ Pascual A . Enfermedades de Transmisi\u00f3n Sexual. Uretritis, vulvovaginitis y cervicitis. Ulceras genitales. Enfermedad p\u00e9lvica inflamatoria. Tratado SEIMC de Enfermedades Infecciosas y Microbiolog\u00eda Cl\u00ednica. Madrid, Spain: Editorial M\u00e9dica Panamericana S.A, 2005:1249\u201362."},{"key":"2024051320474913000_88.4.284.2","first-page":"527","article-title":"Sexually transmitted infections and increased risk of co-infection with human immunodeficiency virus","volume":"104","author":"Nusbaum","year":"2004","journal-title":"J Am Osteopath Assoc"},{"key":"2024051320474913000_88.4.284.3","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1007\/s10156-004-0314-6","article-title":"Incidence of sexually transmitted diseases in Hokkaido, Japan, 1998 to 2001","volume":"10","author":"Takahashi","year":"2004","journal-title":"J Infect Chemother"},{"key":"2024051320474913000_88.4.284.4","doi-asserted-by":"publisher","DOI":"10.1136\/sti.79.6.487"},{"key":"2024051320474913000_88.4.284.5","doi-asserted-by":"publisher","DOI":"10.1086\/499434"},{"key":"2024051320474913000_88.4.284.6","doi-asserted-by":"publisher","DOI":"10.1097\/00007435-199507000-00008"},{"key":"2024051320474913000_88.4.284.7","doi-asserted-by":"publisher","DOI":"10.1016\/S0733-8635(05)70038-3"},{"key":"2024051320474913000_88.4.284.8","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1097\/00007435-199118020-00004","article-title":"Clinical and microbiologic features of urethritis in men in Toulouse, France","volume":"18","author":"Lefevre","year":"1991","journal-title":"Sex Transm Dis"},{"key":"2024051320474913000_88.4.284.9","first-page":"181","volume":"14","author":"Vazquez","year":"1996","journal-title":"Enferm Infecc Microbiol Clin"},{"key":"2024051320474913000_88.4.284.10","doi-asserted-by":"publisher","DOI":"10.1097\/00007435-198304000-00002"},{"key":"2024051320474913000_88.4.284.11","doi-asserted-by":"publisher","DOI":"10.1099\/00222615-21-4-349"},{"key":"2024051320474913000_88.4.284.12","doi-asserted-by":"publisher","DOI":"10.1016\/S0001-7310(06)73409-3"},{"key":"2024051320474913000_88.4.284.13","doi-asserted-by":"publisher","DOI":"10.1055\/s-2008-1070106"},{"key":"2024051320474913000_88.4.284.14","first-page":"157","article-title":"Microbiological features of persistent nonspecific urethritis in men","volume":"40","author":"Ivanov","year":"2007","journal-title":"J Microbiol Immunol Infect"},{"key":"2024051320474913000_88.4.284.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.medmal.2005.10.008"},{"key":"2024051320474913000_88.4.284.16","first-page":"584","article-title":"Mycoplasma hominis and Ureaplasma urealyticum in patients with sexually transmitted diseases","volume":"109","author":"Koch","year":"1997","journal-title":"Wien Klin Wochenschr"},{"key":"2024051320474913000_88.4.284.17","doi-asserted-by":"publisher","DOI":"10.1086\/511144"},{"key":"2024051320474913000_88.4.284.18","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.00952-06"},{"key":"2024051320474913000_88.4.284.19","doi-asserted-by":"publisher","DOI":"10.1111\/j.1442-2042.2006.01591.x"},{"key":"2024051320474913000_88.4.284.20","doi-asserted-by":"publisher","DOI":"10.1097\/01.olq.0000175390.45315.a1"},{"key":"2024051320474913000_88.4.284.21","doi-asserted-by":"publisher","DOI":"10.1258\/ijsa.2007.007199"},{"key":"2024051320474913000_88.4.284.22","doi-asserted-by":"publisher","DOI":"10.1258\/ijsa.2008.008118"},{"key":"2024051320474913000_88.4.284.23","unstructured":"Hell\u00edn T Rodriguez A Ribera A . Protocolos Cl\u00ednicos SEIMC n\u00b0 VIII. Enfermedades de Transmisi\u00f3n Sexual. Sociedad Espa\u00f1ola de Enfermedades Infecciosas y Microbiolog\u00eda Cl\u00ednica. http:\/\/www.seimc.org"},{"key":"2024051320474913000_88.4.284.24","doi-asserted-by":"publisher","DOI":"10.1007\/s11908-008-0023-x"}],"container-title":["Sexually Transmitted Infections"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/sextrans-2011-050150","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,14]],"date-time":"2024-05-14T04:06:43Z","timestamp":1715659603000},"score":1,"resource":{"primary":{"URL":"https:\/\/sti.bmj.com\/lookup\/doi\/10.1136\/sextrans-2011-050150"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2012,2,2]]},"references-count":24,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2012,5,12]]},"published-print":{"date-parts":[[2012,6]]}},"alternative-id":["10.1136\/sextrans-2011-050150"],"URL":"https:\/\/doi.org\/10.1136\/sextrans-2011-050150","relation":{},"ISSN":["1368-4973","1472-3263"],"issn-type":[{"value":"1368-4973","type":"print"},{"value":"1472-3263","type":"electronic"}],"subject":[],"published":{"date-parts":[[2012,2,2]]}}}