Non-gonococcal urethritis

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Non-gonococcal urethritis
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Nongonococcal urethritis (NGU) is inflammation of the urethra that is not caused by gonorrheal infection. [1]

Contents

For treatment purposes, doctors usually classify infectious urethritis in two categories: gonococcal urethritis, caused by gonorrhea, and nongonococcal urethritis (NGU). [2]

Symptoms and signs

The symptoms of urethritis can include pain or a burning sensation upon urination (dysuria), a white/cloudy discharge and a feeling that one needs to pass urine frequently. For men, the signs and symptoms are discharge from the penis, burning or pain when urinating, itching, irritation, or tenderness. In women, the signs and symptoms are discharge from vagina, burning or pain when urinating, anal or oral infections, abdominal pain, or abnormal vaginal bleeding, which may be an indication that the infection has progressed to Pelvic Inflammatory Disease.

NGU is transmitted by touching the mouth, penis, vagina or anus by penis, vagina or anus of a person who has NGU.

NGU is more common in men than women. Men may have a discharge (strange liquid) from the penis, pain when urinating, and itching, irritation or tenderness around the opening of the penis. Women might not have any symptoms and may not know they have NGU until severe problems occur. Women might have discharge from the vagina, burning or pain when urinating, pain in the abdominal (stomach) area, or bleeding from the vagina that is not from a monthly period. (This may be an sign that NGU has become worse and turned into Pelvic Inflammatory Disease, or PID).

Causes

There are many causes of NGU. This is in part due to the large variety of organisms living in the urinary tract. Ureaplasma urealyticum and Mycoplasma genitalium are some of the culprits.[ clarification needed ] NGU is also associated with reactive arthritis, in which the triad of arthritis, conjunctivitis, and urethritis is seen.

Bacterial

The most common bacterial cause of NGU is Chlamydia trachomatis,[ citation needed ] but it can also be caused by Ureaplasma urealyticum , Haemophilus vaginalis , Mycoplasma genitalium , Mycoplasma hominis , Neisseria meningitidis , Gardnerella vaginalis , Acinetobacter lwoffii , Acinetobacter calcoaceticus , and E.coli .

Viral

Herpes simplex virus, Adenovirus, Cytomegalovirus [ citation needed ]

Fungi

Candida Albicans

Parasitic

Parasitic causes include Trichomonas vaginalis (rare).[ citation needed ]

Noninfectious

Urethritis can be caused by mechanical injury (from a urinary catheter or a cystoscope), or by an irritating chemical (antiseptics or some spermicides).

Diagnosis

It has been easy to test for the presence of gonorrhea by viewing a Gram stain of the urethral discharge under a microscope: The causative organism is distinctive in appearance; however, this works only with men because other non-pathogenic gram-negative microbes are present as normal flora of the vagina in women. Thus, one of the major causes of urethritis can be identified (in men) by a simple common test, and the distinction between gonococcal and non-gonococcal urethritis arose for this reason.

Non-gonococcal urethritis (NGU) is diagnosed if a person with urethritis has no signs of gonorrhea bacteria on laboratory tests.

In men, the most frequent cause of NGU (15%-55% of cases) is C. trachomatis . [3]

Idiopathic urethritis or non-specific urethritis

Historically, the terms idiopathic urethritis (US English) [4] or non-specific urethritis (British English) [5] have been used as synonyms for nongonococcal urethritis. "Idiopathic" and "non-specific" are medical term meaning "specific cause has not been identified", and in this case refers to the detection of urethritis, and the testing for but found negative of gonorrhea. In this sense, the most likely cause of NSU is a chlamydia infection.

However, the term NSU is sometimes distinguished and used to mean that both gonorrhea and chlamydia have been ruled out. [6] Thus, depending on the sense, chlamydia can either be the most likely cause or have been ruled out, and frequently detected organisms are Ureaplasma urealyticum and Mycoplasma hominis .

However, in 20-50% of cases, a specific cause for urethritis can't be identified, in which case a diagnosis of idiopathic urethritis is a diagnosis of exclusion. [4]

Treatment

Treatment is based on the prescription and use of the proper antibiotics depending on the strain of the ureaplasma. [7]

Because of its multi-causative nature, initial treatment strategies involve using a broad range antibiotic that is effective against chlamydia (such as doxycycline).[ medical citation needed ] It is imperative that both the patient and any sexual contacts be treated. Women infected with the organisms that cause NGU may develop pelvic inflammatory disease. If symptoms persist, follow-up with a urologist may be necessary to identify the cause.

According to a study, tinidazole used with doxycycline or azithromycin may cure NGU better than when doxycycline or azithromycin is used alone. [8]

If left untreated, complications include epididymitis and infertility. Consistent and correct use of latex condoms during sexual activity greatly reduces the likelihood of infection. [9]

See also

Related Research Articles

<span class="mw-page-title-main">Chlamydia</span> Sexually transmitted infection caused by the bacterium Chlamydia trachomatis

Chlamydia, or more specifically a chlamydia infection, is a sexually transmitted infection caused by the bacterium Chlamydia trachomatis. Most people who are infected have no symptoms. When symptoms do appear they may occur only several weeks after infection; the incubation period between exposure and being able to infect others is thought to be on the order of two to six weeks. Symptoms in women may include vaginal discharge or burning with urination. Symptoms in men may include discharge from the penis, burning with urination, or pain and swelling of one or both testicles. The infection can spread to the upper genital tract in women, causing pelvic inflammatory disease, which may result in future infertility or ectopic pregnancy.

<i>Mycoplasma genitalium</i> Species of bacterium

Mycoplasma genitalium is a sexually transmitted, small and pathogenic bacterium that lives on the mucous epithelial cells of the urinary and genital tracts in humans. Medical reports published in 2007 and 2015 state that Mgen is becoming increasingly common. Resistance to multiple antibiotics, including the macrolide azithromycin, which until recently was the most reliable treatment, is becoming prevalent. The bacteria was first isolated from the urogenital tract of humans in 1981, and was eventually identified as a new species of Mycoplasma in 1983. It can cause negative health effects in men and women. It also increases the risk factor for HIV spread with higher occurrences in those previously treated with the azithromycin antibiotics.

<span class="mw-page-title-main">Pelvic inflammatory disease</span> Infection of uterus, fallopian tubes, ovaries or the inner surface of pelvis

Pelvic inflammatory disease, also known as pelvic inflammatory disorder (PID), is an infection of the upper part of the female reproductive system, namely the uterus, fallopian tubes, and ovaries, and inside of the pelvis. Often, there may be no symptoms. Signs and symptoms, when present, may include lower abdominal pain, vaginal discharge, fever, burning with urination, pain with sex, bleeding after sex, or irregular menstruation. Untreated PID can result in long-term complications including infertility, ectopic pregnancy, chronic pelvic pain, and cancer.

<span class="mw-page-title-main">Urethra</span> Tube that connects the urinary bladder to the external urethral orifice

The urethra is a tube that connects the urinary bladder to the urinary meatus for the removal of urine from the body of both females and males. In human females and other primates, the urethra connects to the urinary meatus above the vagina, whereas in marsupials, the female's urethra empties into the urogenital sinus.

Urethritis is the inflammation of the urethra. The most common symptoms include painful or difficult urination and urethral discharge. It is a commonly treatable condition usually caused by infection with bacteria. This bacterial infection is often sexually transmitted, but not in every instance; it can be idiopathic, for example. Some incidence of urethritis can appear asymptomatic as well.

<i>Neisseria gonorrhoeae</i> Species of bacterium

Neisseria gonorrhoeae, also known as gonococcus (singular), or gonococci (plural), is a species of Gram-negative diplococci bacteria isolated by Albert Neisser in 1879. It causes the sexually transmitted genitourinary infection gonorrhea as well as other forms of gonococcal disease including disseminated gonococcemia, septic arthritis, and gonococcal ophthalmia neonatorum.

Vaginitis, also known as vulvovaginitis, is inflammation of the vagina and vulva. Symptoms may include itching, burning, pain, discharge, and a bad smell. Certain types of vaginitis may result in complications during pregnancy.

<span class="mw-page-title-main">Cervicitis</span> Inflammation of the uterine cervix

Cervicitis is inflammation of the uterine cervix. Cervicitis in women has many features in common with urethritis in men and many cases are caused by sexually transmitted infections. Non-infectious causes of cervicitis can include intrauterine devices, contraceptive diaphragms, and allergic reactions to spermicides or latex condoms. Cervicitis affects over half of all women during their adult life.

<span class="mw-page-title-main">Epididymitis</span> Medical condition

Epididymitis is a medical condition characterized by inflammation of the epididymis, a curved structure at the back of the testicle. Onset of pain is typically over a day or two. The pain may improve with raising the testicle. Other symptoms may include swelling of the testicle, burning with urination, or frequent urination. Inflammation of the testicle is commonly also present.

<span class="mw-page-title-main">Fitz-Hugh–Curtis syndrome</span> Medical condition

Fitz-Hugh–Curtis syndrome is a rare complication of pelvic inflammatory disease (PID) involving liver capsule inflammation leading to the creation of adhesions. The condition is named after the two physicians, Thomas Fitz-Hugh, Jr and Arthur Hale Curtis who first reported this condition in 1934 and 1930 respectively.

<i>Ureaplasma urealyticum</i> Species of bacterium

Ureaplasma urealyticum is a bacterium belonging to the genus Ureaplasma and the family Mycoplasmataceae in the order Mycoplasmatales. This family consists of the genera Mycoplasma and Ureaplasma. Its type strain is T960. There are two known biovars of this species; T960 and 27. These strains of bacteria are commonly found as commensals in the urogenital tracts of human beings, but overgrowth can lead to infections that cause the patient discomfort. Unlike most bacteria, Ureaplasma urealyticum lacks a cell wall making it unique in physiology and medical treatment.

<span class="mw-page-title-main">Mycoplasmataceae</span> Family of bacteria

Mycoplasmataceae is a family of bacteria in the order Mycoplasmatales. This family consists of the genera Mycoplasma and Ureaplasma.

<span class="mw-page-title-main">Reactive arthritis</span> Medical condition

Reactive arthritis, also known as Reiter's syndrome, is a form of inflammatory arthritis that develops in response to an infection in another part of the body (cross-reactivity). Coming into contact with bacteria and developing an infection can trigger the disease. By the time the patient presents with symptoms, often the "trigger" infection has been cured or is in remission in chronic cases, thus making determination of the initial cause difficult.

<span class="mw-page-title-main">Salpingitis</span> Medical condition

Salpingitis is an infection causing inflammation in the fallopian tubes. It is often included in the umbrella term of pelvic inflammatory disease (PID), along with endometritis, oophoritis, myometritis, parametritis, and peritonitis.

<span class="mw-page-title-main">Vaginal discharge</span> Medical condition

Vaginal discharge is a mixture of liquid, cells, and bacteria that lubricate and protect the vagina. This mixture is constantly produced by the cells of the vagina and cervix, and it exits the body through the vaginal opening. The composition, amount, and quality of discharge varies between individuals and can vary throughout the menstrual cycle and throughout the stages of sexual and reproductive development. Normal vaginal discharge may have a thin, watery consistency or a thick, sticky consistency, and it may be clear or white in color. Normal vaginal discharge may be large in volume but typically does not have a strong odor, nor is it typically associated with itching or pain. While most discharge is considered physiologic or represents normal functioning of the body, some changes in discharge can reflect infection or other pathological processes. Infections that may cause changes in vaginal discharge include vaginal yeast infections, bacterial vaginosis, and sexually transmitted infections. The characteristics of abnormal vaginal discharge vary depending on the cause, but common features include a change in color, a foul odor, and associated symptoms such as itching, burning, pelvic pain, or pain during sexual intercourse.

<span class="mw-page-title-main">Grepafloxacin</span> Chemical compound

Grepafloxacin was an oral broad-spectrum fluoroquinolone antibacterial agent used to treat bacterial infections. Grepafloxacin was withdrawn worldwide from markets in 1999, due to its side effect of lengthening the QT interval on the electrocardiogram, leading to cardiac events and sudden death.

<span class="mw-page-title-main">Gonorrhea</span> Sexually transmitted infection

Gonorrhoea or gonorrhea, colloquially known as the clap, is a sexually transmitted infection (STI) caused by the bacterium Neisseria gonorrhoeae. Infection may involve the genitals, mouth, or rectum. Infected men may experience pain or burning with urination, discharge from the penis, or testicular pain. Infected women may experience burning with urination, vaginal discharge, vaginal bleeding between periods, or pelvic pain. Complications in women include pelvic inflammatory disease and in men include inflammation of the epididymis. Many of those infected, however, have no symptoms. If untreated, gonorrhea can spread to joints or heart valves.

<span class="mw-page-title-main">Sexually transmitted infection</span> Infection transmitted through human sexual behavior

A sexually transmitted infection (STI), also referred to as a sexually transmitted disease (STD) and the older term venereal disease (VD), is an infection that is spread by sexual activity, especially vaginal intercourse, anal sex, oral sex, or sometimes manual sex. STIs often do not initially cause symptoms, which results in a risk of passing the infection on to others. Symptoms and signs of STIs may include vaginal discharge, penile discharge, ulcers on or around the genitals, and pelvic pain. Some STIs can cause infertility.

Ureaplasma parvum is a species of Ureaplasma, a genus of bacteria belonging to the family Mycoplasmataceae. In Indonesia, ureaplasma parvum is most commonly contracted through contact with public toilets.

<span class="mw-page-title-main">Penile discharge</span> Medical condition

Penile discharge is fluid that comes from the urethra at the end of the penis that is not urine, pre-ejaculate or semen.

References

  1. Territo, Heather; Ashurst, John V. (2023). "Nongonococcal Urethritis". StatPearls. StatPearls Publishing. PMID   30571032.
  2. Burstein GR, Zenilman JM (January 1999). "Nongonococcal urethritis—a new paradigm". Clin. Infect. Dis. 28 (Suppl 1): S66–73. doi: 10.1086/514728 . PMID   10028111.
  3. Ferri, Fred F. (2023). "Chlamydia genital infections". Ferri's Clinical Advisor 2024. Philadelphia: Elsevier. p. 356. ISBN   978-0-323-75576-4.
  4. 1 2 Wetmore, Catherine M.; Manhart, Lisa E.; Golden, Matthew R. (November 2009). "Idiopathic urethritis in young men in the United States: prevalence and comparison to infections with known sexually transmitted pathogens". The Journal of Adolescent Health. 45 (5): 463–472. doi:10.1016/j.jadohealth.2009.06.024. ISSN   1054-139X. PMC   2764555 . PMID   19837352.
  5. Non-specific Urethritis (NSU) Archived 2012-03-17 at the Wayback Machine , NHS, Genito-Urinary Medicine (GUM)
  6. Non-specific urethritis (NSU) and Cervicitis
  7. "Nongonococcal Urethritis (NGU)". BC HealthFile. Retrieved 2008-01-01.
  8. Clinical trial number NCT00322465 for "NGU: Doxycycline (Plus or Minus Tinidazole) Versus Azithromycin (Plus or Minus Tinidazole)" at ClinicalTrials.gov
  9. "Non-Gonococcal Urethritis (NGU)". MyHealth.Alberta.ca . Retrieved 2021-03-23.