Management of non-gonococcal urethritis

Abstract

Non-gonococcal urethritis (NGU), or inflammation of the urethra, is the most common treatable sexually transmitted syndrome in men, with approximately 20-50 % of cases being due to infection with Chlamydia trachomatis and 10-30 % Mycoplasma genitalium. Other causes are Ureaplasma urealyticum, Trichomonas vaginalis, anaerobes, Herpes simplex virus (HSV) and adenovirus. Up to half of the cases are non-specific. Urethritis is characterized by discharge, dysuria and/or urethral discomfort but may be asymptomatic. The diagnosis of urethritis is confirmed by demonstrating an excess of polymorpho-nuclear leucocytes (PMNLs) in a stained smear. An excess of mononuclear leucocytes in the smear indicates a viral etiology. In patients presenting with symptoms of urethritis, the diagnosis should be confirmed by microscopy of a stained smear, ruling out gonorrhea. Nucleid acid amplifications tests (NAAT) for Neisseria gonorrhoeae, C. trachomatis and for M. genitalium. If viral or protozoan aetiology is suspected, NAAT for HSV, adenovirus and T. vaginalis, if available. If marked symptoms and urethritis is confirmed, syndromic treatment should be given at the first appointment without waiting for the laboratory results. Treatment options are doxycycline 100 mg x 2 for one week or azithromycin 1 gram single dose or 1,5 gram distributed in five days. However, azithromycin as first line treatment without test of cure for M. genitalium and subsequent Moxifloxacin treatment of macrolide resistant strains will select and increase the macrolide resistant strains in the population. If positive for M. genitalium, test of cure samples should be collected no earlier than three weeks after start of treatment. If positive in test of cure, moxifloxacin 400 mg 7–14 days is indicated. Current partner(s) should be tested and treated with the same regimen. They should abstain from intercourse until both have completed treatment. Persistent or recurrent NGU must be confirmed with microscopy. Reinfection and compliance must be considered. Evidence for the following recommendations is limited, and is based on clinical experience and guidelines. If doxycycline was given as first therapy, azithromycin five days plus metronidazole 4–500 mg twice daily for 5–7 days should be given. If azithromycin was prescribed as first therapy, doxycycline 100 mg x 2 for one week plus metronidazole, or moxifloxacin 400 mg orally once daily for 7–14 days should be given.

Anal Ureaplasma spp. positivity among HIV positive men who have sex with men may be associated with high-risk-type HPV infections

“…colonize genitourinary tracts of both healthy and symptomatic individuals. Whereas some studies suggested U. parvum to be more common in the urine samples of symptomatic men (Cox et al, 2016;Strauss et al, 2018;Deguchi et al, 2015) others found that U. urealyticum but not U. parvum to be associated with symptoms of urethritis (Zhang et al, 2014;Moi et al, 2015;Frølund et al, 2016). The role of Ureaplasma colonization in the anal mucosa has never been presented before.…”

Chlamydia trachomatis and HPV co‐infections in HIV negative men from a multi‐ethnic area of Northern Italy at high prevalence of cervical malignancies

“…Non‐gonococcal urethritis (NGU) is the most common treatable sexually transmitted syndrome in men, with approximately 20‐50% of cases due to infection with C. trachomatis . C. trachomatis is the most commonly reported and notifiable infection in Europe, including in Italy, affecting predominantly the lower urogenital tract, although extra‐genitals sites such as the ocular, anorectal, and pharyngeal tissues can be affected .…”

Modern Antibacterial Therapy of Non-Gonococcal Urethritis: Challenges and Solutions

“…Самый распространенный возбудитель НГУ -Chlamydia trachomatis (11- [1]. Реже при НГУ выявляются уреаплазмы (11-26%), трихомонады (1-20%), аденовирусы (2-4%) и вирус простого герпеса (2-3%) [8,9]. Выделение Trichomonas vaginalis зависит от локального уровня распространенности данного микроорганизма в популяции.…”