Non-specific urethritis associated with a tetracycline-resistant T-mycoplasma.

Abstract

CanadaWhile the causes of venereally-acquired non-specific urethritis in men remain debatable, there is strong evidence that a tetracycline-sensitive infective agent is responsible for the majority of cases. Because the urethritis is abacterial, either mycoplasmas (Shepard, 1968;Ford, 1970;McCormack, Braun, Lee, Klein, and Kass, 1973) or Chlamydia (Dunlop, VaughanJackson, Darougar, and Jones, 1972;Oriel, Reeve, Powis, Miller, and Nicol, 1972;Richmond, Hilton, and Clarke, 1972) have become the main contenders for an aetiological role and a voluminous literature supports each viewpoint. The evidence supporting T-mycoplasmas as a major cause of non-specific urethritis consists of their high isolation rate of above 60 per cent. in most studies, and their sensitivity to tetracycline and erythromycin (Shepard, Lunceford, and Baker, 1966), but resistance to lincomycin (Csonka and Spitzer, 1969) which accords with the response of the disease to these antibiotics. The present report concerns the isolation of a T-mycoplasma highly resistant to tetracycline, in a patient whose urethritis was unaffected by the antibiotic. Case report A 36-year-old businessman had been seen by one of us (D.K.F.) on nine occasions in the previous 15 years for non-specific urethritis. On each of these occasions there was an associated pain in the left knee and on the first five occasions the left knee was observed to be swollen and warm; on one occasion there was an associated conjunctivitis and on another the right wrist was also found to be swollen and warm. The episodes of acute arthritis, however, never lasted longer than 2 to 4 weeks. On two occasions he had minimal circinate balanitis, but at no time keratoderma blennorrhagica. Previous treatment for the urethritis had always been with tetracycline and the urethral symptoms had always cleared promptly.In August, 1973, he complained of an urethral discharge which followed an extramarital exposure a few days previously. He had ceased to have intercourse with his wife because the marriage was breaking up. He also Received for publication December 5, 1973 complained of some pain in the left knee but this was not swollen. He was treated with tetracycline 500 mg. three times daily for 10 days and was not seen again for 2 months.In October, 1973, he returned and stated that the discharge had never completely cleared after the previous tetracycline treatment. He denied any further exposures. ExaminationThere was a moderately profuse mucopurulent discharge. Microscopical examination of the urethral smear stained by Gram's method showed many polymorphs, scattered diphtheroids, but no gonococci or yeasts. He was started on tetracycline 500 mg. three times daily.He returned 5 days later and stated that the discharge was unaffected by the tetracycline, which he had taken as prescribed. He was found to have a moderately profuse purulent discharge. Because of the unusual circumstances, the hospital bacteriologist was called in consultation and both Gram-stained and wet preparations were examined wit...

Prolonged eradication of urogenital mycoplasmas after administration of tetracycline to men in the Antarctic.

“…The recurrence or continued presence of ureaplasmas after treatment may also be due to the existence of organisms which are relatively tetracycline-resistant. These have been found in Canada (Ford and Smith, 1974) and in England (Prentice, Taylor-Robinson, and Csonka, 1976). It is noteworthy that all the strains examined in the present study were highly sensitive to the antibiotic in vitro.…”

Non-gonococcal urethritis due to T-mycoplasma (Ureaplasma urealyticum) serotype 2 in a conjugal sexual partnership.

“…The following clinical study suggests a causative role in the recurrent urethritis suffered by the husband of one conjugal sexual partnership, and it supports a recent case report (Ford and Smith, 1974) that T-mycoplasmas can, in at least specific circumstances, cause urethritis. Case report A man aged 50 years was referred to one of us (DKF) in October, 1974, for recurrent non-gonococcal uretbritis.…”

Dissemination of the tetM tetracycline resistance determinant to Ureaplasma urealyticum

“…Tetracycline is the drug commonly used to treat infections caused by U. urealyticum (20). A high-level tetracycline-resistant (Tcr) strain was first isolated in 1974 (6). Now 6 to 10% of the Seattle isolates are resistant (24).…”