Letters to the Editor

Dear Editor,

I read with interest the article on male urinary tract infection in primary care in your June 2015 issue. I have the follow comments to make.

The authors did not indicate whether the analysis was performed only on culture positive cases. I suspect that there might be patients having lower urinary tract symptoms with negative culture.

The authors had not addressed the possibility of sexual transmitted diseases as causes of UTI in young males. Conventional urine culture would not be able to detect Neisseria gonorrhoea or Chlamydia trachomatis infections. Making a diagnosis basing on MSU culture would miss STD as a cause of UTI.

In older males, prostatitis and LUTS should be excluded and Amoxicillin-Clavulanate combination may not be the right choice for empirical treatment.

Base on the sens it ivity results , if one uses Amoxicillin-Clavulanate combination as treatment, the 70% response rate may be too low for a family physician treating male UTI.

UTI in males usually is considered complicated in contrast to UTI in females. It will warrant further investigations and follow up; besides giving the appropriate antibiotic for a sufficient duration.

Finally, the number of patients was too small to make any useful guideline for a family physician who works in a private clinic. There may be more patients having STDs who do not want to be treated in the public settings.

Authors’ reply

Dear Editor,

We would like to thank Dr Ho for his letter.

We agree with Dr Ho that urinary tract infections in male are considered as a complication in urinary tract infections in general. Therefore, in our study, all male patients presenting with acute lower urinary tract symptoms were offered investigations with mid-stream urine culture and antibiotics sensitivity test. In our study, we only included those culture positive cases. For symptomatic patients with negative culture results, we offered follow up with further clinical assessment and they were excluded from our study.

We also think that sexually transmitted disease (STD) and prostatitis are the differential diagnoses for acute lower urinary tract symptoms. In fact, our doctors would ask about the history for STD and prostatitis in male patients with lower urinary tract symptoms. In this retrospective study, our patients who were suspected to have sexually transmitted disease or prostatitis by the attending physician were offered further investigations and were all excluded in our study.

In our study, 70% of the positive culture urine specimens responded to Amoxicillin-Clavulanate which was higher compared to using Nitrofurantoin. This finding supports our viewpoint that antibiogram from the hospital might not be a very accurate reference for primary care.

We addressed and pointed out that our sample size was a limitation of our study. Further studies involving more centres could be considered in order to produce more generalisable results. Moreover, collaboration with hospital microbiology departments in the future can produce a more comprehensive analysis.