Non-Gonococcal Urethritis: Health Relevance, Clinical Presentations, Epidemiology And Treatment
Symptoms Of Non-Gonococcal Urethritis
Urethritis, from which gonococci cannot be isolated, is termed as non-gonococcal urethritis (NGU). While in men, the condition is well defined, in women it is not. The possible causative organisms are Chlamydia trachomatis in 60% cases, Ureaplasma urealyticum and less frequently others. Other pathogens such as Herpes simplex virus, Trichomonas Vaginalis, and Candida albicans may rarely produce the picture of NGU. In a proportion of patients organisms may not be identified.
Epidemiology: Non-gonococcal urethritis occurs world-wide and it is common in India. Infection is initially acquired by sexual intercourse, though relapses may occur within such contact. The chain of transmission is not as clearcut as in gonorrhea. This infection develops only in a few of the sexual partners of the patients in both sexes. The reason for this phenomenon is not known.
NGU in Men: The incubation period ranges from a few days to two months. This wide range may suggest the possibility of different pathogens. Clinical features resemble a mild attack of gonorrhea with a subacute onset and a watery, mucoid, mucopurulent or rarely frankly purulent urethral discharge. Gram staining shows the absence of gonococci. Even in untreated cases, the urethritis subsides, but mild exacerbations occur from time to time. Treatment with tetracycline, which is the drug of choice, rapidly clears the condition in 90% of cases. Non0gonococcal proctitis may occur in homosexual individuals.
Post-gonococcal urethrisits (PGU): This term is used for cases of gonococcal urethritis who develop non-gonococcal urethritis after successful treatment with penicillin. It is possible that these patients harbor the organisms of gonorrhea and NGU simulataneously.
Local complications of NGU and PGU: Local abscesses may develop in some cases. Acute unilateral epididymis develops rarely. Chronic prostatitis is the most common complication. Identification of this condition may not be easy. The most significant symptom is prostatic pain which is felt in the perineal region as a vague discomfort and this may be referred to the groins, thighs and suprapubic region. Presence of pus cells and numerous prostatic threads in the first sample of urine collected after prostatic massage suggests prostatitis. Around 1 to 2% of males who develop NGU may suffer from Reiter’s syndrome later.
Non gonococcal genital infections in women: This infection is much less clearcut in women than in men. Some women may complain of vaginal discharge. The most important manifestation is salpingitis, which may extend to pelvic tissues to produce pelvic inflammatory disease. Perihepatitis, bartholinitis, postpartum and post-abortal fever, ascending pyelonephritis, infertility and birth of underweight babies have all been recorded as complications.
Non-gonococcal Infections In Infants and Children: Infections may be acquired by the baby during birth from the maternal genital passages. The newborn may develop non-gonococcal ophthalmia neonatorum and infantile pneumonia caused by C. trachomatis.
Oxytetracycline Is The Drug Of Choice
Treatment of Non-Gonococcal Genital Infections
Oxytetracycline is the drug of choice, given in a dose of 250 mg., four times a day for seven days. Chlamydia may require longer courses, i.e, oxytetracycline 250 mg four times a day for 21 days or 500 mg four times a day for 14 days are alternative regimens. Female partners are also routinely treated to prevent complications in them.
© 2014 Funom Theophilus Makama