Non-specific urethritis and the tetracyclines.

Abstract

Non-specific urethritis (NSU) is treated as an entity, yet it includes cases of urethral inflammation presumed to be related to the presence of probably several specific organisms. The effectiveness of the tetracycline group of antibiotics in comparison with other forms of treatment is not in doubt (Wilcox, 1972). In the present study we wish to remark upon the aetiology of NSU and to discover whether tetracycline treatment can assist us in understanding the nature of NSU, and also to comment on the best application of tetracycline therapy.NSU Sompolinsky, Harari, Solomon, Caspi, Krakowski, and Henig, 1973;Wentworth, Bonin, Holmes, Gutman, Wiesner, and Alexander, 1973). Yet the role of this agent, although probably at times a pathogen, is still questionable (Richmond, Hilton, and Clarke, 1972;Hilton, Richmond, Milne, Hindley, and Clarke, 1974;Oriel, Powis, Reeve, Miller, and Nicol, 1974).It may be that Chlamydia agent plays an 'opportunist' role, and acts both as pathogen and as 'potential pathogen' in the genito-urinary tract. Much of this work is relatively new and still continuing. A recent study on the presence of antibodies to Chlamydia in patients with urethritis, and in persons without urethritis, does not make the position any clearer (Reeve, Gerloff, Casper, Philip, Oriel, and Powis, 1974). Mycoplasma hominis (and to a much lesser extent M. fermentans and M. salivarius) and T-strain mycoplasma can be present in those with a healthy genito-urinary epithelium as well as in those in whom the epithelium is inflamed. It would appear from the evidence that the T-strain may be present in over 60 per cent. of cases of urethritis, and M. hominis in about 20 per cent. of cases.

Tetracycline treatment for non-specific urethritis.

“…It may be more helpful to try to distinguish the cases in which there is a marker-such as Chlamydia trachomatis, Trichomonas vaginalis, or the herpes simplex virus-or some other identifiable feature. In this way we may explain the apparently irreconcilable findings that led Weston (1965) to suggest that allergy may have an important aetiological role, Grimble and Amarasuriya (1975) to postulate mixed infections, and Evans (1977) We fail to see how these figures could be taken to 'incline the reader to caution' in accepting our results. Mr Simopoulos also chides us for not having used a placebo in the trial.…”

Diagnostic, treatment, and reporting criteria for non-specific genital infection in sexually transmitted disease clinics in England and Wales. 2: Treatment and reporting criteria.

“…Some authors have suggested that triple tetracycline is more effective than oxytetracycline in the treatment of NSU (Bhattacharyya and Morton, 1973), but this is disputed by other workers (Willcox, 1972;Grimble and Amarasuriya, 1975). These conflicting reports indicate that no good scientific evidence exists for the use of triple tetracycline in preference to tetracycline.…”

“…This longer period may have been because the patient was Chlamydiapositive or because it was considered that a better cure rate could be obtained. The latter possibility has been suggested by John (1971) but since disputed by several authors (Willcox, 1972;Helmy and Fowler, 1975;Grimble and Amarasuriya, 1975). There would appear to be no justification for prescribing tetracycline or oxytetracycline for more than five to seven days unless a clear diagnosis of chlamydial infection has been made.…”

Chlamydia: A Disease without a History

“…76 In the same year a study based on patients at Guy's Hospital in London concluded that only 20 percent were "truly non-specific"; the remainder broke down as follows: chlamydia, 40 percent; mycoplasma, 20 percent; trichomoniasis, 15 percent; and candidiasis, 5 percent. 77 The diversity of diseases making up NSU remained a challenge and, according to Robbie Morton, a venereologist based in Sheffield, "In spite of much laboratory and other research, nonspecific genital infection continues to be the venereologist's most perplexing problem, clinically, diagnostically and therapeutically." 78 In 1978, Michael Adler, then at the Middlesex Hospital and following a review of the diagnosis and reporting of NSU, wrote, "It is extremely unsatisfactory that when the disease is discussed, described, diagnosed, and notified no accepted criteria are in existence" and "The commonest diagnosis made in STD clinics [is] the one with the least uniformity."…”