Problems with Non-Gonococcal Urethritis

A comparison of clinical features between chlamydial and non-chlamydial urethritis in men negative for gonococcal infection who attended a urological outpatient clinic in Japan

“…The incubation period in the CU group was significantly longer than that in the NCU group, and the incidence of comparatively severe symptoms, such as urethral discharge and burning on urination, was significantly greater in the NCU group than in the CU group. Several previous studies have reported findings similar to those in this series [2,3,8]. As a result, the CU group was less likely to attend the clinic early after the appearance of symptoms compared with the NCU group.…”

“…In the field of urology, urethritis in men has historically been classified into gonococcal or non-gonococcal disease and is the most frequently observed STD. Recently, several studies have reported an alarming increase in the incidence of non-gonococcal urethritis, including asymptomatic infection [2]. Despite several pathogens causing non-gonococcal urethritis, such as Ureaplasma urealyticum and Mycoplasma genitalium, the most potent pathogen is Chlamydia trachomatis [3].…”

“…The recent incidence of non-gonococcal urethritis has increased markedly compared with that of gonococcal urethritis, and the morbidity and complications of non-gonococcal urethritis may be equal to or even greater than those of gonococcal urethritis. However, non-gonococcal urethritis is frequently accompanied by mild symptoms, and its usual incubation period is comparatively long; therefore, both patients with non-gonococcal urethritis and their sexual partners are infrequently diagnosed and properly treated [2]. Accordingly, the incidence of nongonococcal urethritis and its associated infectious diseases will probably continue to increase, and establishing a useful strategy for the control of non-gonococcal urethritis is expected to become a worldwide problem.…”

2009 European Guideline on the Management of Male Non-gonococcal Urethritis

“…It is empirically defined as persistent or recurrent symptomatic urethritis occurring 30-90 days following treatment of acute NGU 70 and occurs in 10-20% of patients; 70 -73 † Its aetiology is probably multifactorial. 34,59,70 M. genitalium may be implicated in 20-40% 57,70 and the current treatments for NGU do not always eradicate this organism. 55,57,58 In a randomized study of 398 men, 1 g of azithromycin resulted in failure in 16% and doxycycline 100 mg twice a day for seven days in 64% of those who returned for follow-up.…”

“…However, assessing treatment efficacy is problematic, as no pathogen is identifiable in the majority of cases, and the inflammatory process may not reflect persistent infection. 34 It is important to note that the inflammatory exudate may persist for a variable length of time even when the putative organism has been eliminated. 53 Venereophobia is a classical cause of urethral discharge, induced by regular squeezing: in that particular case, the absence of PMNLs on examining the urethral smear or FPU must discourage giving recurrent antibiotic treatments.…”