Non-gonococcal urethritis (NGU) is a type of urethritis transmitted by sexual contact with clinically significant symptoms of urethritis or cervicitis, but no gonococcus can be detected in the discharge, hence the term non-gonococcal urethritis. The pathogens of infection are mainly Chlamydia trachomatis, Mycoplasma solium and Mycoplasma humanum, and of course Trichomonas, Herpes simplex virus and Candida albicans. In recent years, the number of cases of the disease in China has been increasing, which should attract attention. There are 40% to 50% of non-gonococcal urethritis caused by Chlamydia trachomatis; there are 30% of non-gonococcal urethritis caused by mycoplasma.
Pathogenic agents.
Chlamydia is a class of microorganisms that can pass through the filter, strictly intracellular parasitic, have a unique life cycle in the host cell, containing deoxyribonucleic acid (DNA) and ribonucleic acid (RNA) two types of nucleic acids to bifurcate reproduction, complete a cycle of about 48-72h, proliferate in the infected cells to form various forms of inclusion bodies.
Mycoplasma is one of the smallest and simplest prokaryotes that can live independently. Mycoplasma urealyticum (serotype I-VIII) is the only recognized species of Mycoplasma urealyticum, which is characterized by the presence of urea-activating enzymes. Human mycoplasma (with at least three serotypes) is a genus of mycoplasma. Both genera belong to the same family and are characterized by the need for cholesterol or other steroids for growth and the need for urea for the growth of Mycoplasma solani.
Transmission routes.
The source of infection of non-gonococcal urethritis is the patient, mainly through sexual relations, as with other sexually transmitted diseases, which tend to occur in young and middle-aged sexually active period, one spouse is prone to infect the other, pregnant women infected with chlamydia and mycoplasma can infect the newborn during delivery. Transmission routes: ① Direct sexual contact infection, when having intercourse with a patient suffering from non-gonococcal urethritis. (2) Indirect contact infection, using the clothes, bedding, towels, bath tubs, flush toilets, etc. used by patients with non-gonococcal urethritis. ③Infection from the birth canal, where a mother with nongonococcal urethritis infects her newborn through the birth canal. In addition, the obstetrician and gynecologist and the mother’s fingers are an important way to bring pathogens to the newborn. Mycoplasma can be isolated from amniotic fluid, placenta and fetal blood when the membranes are intact, thus demonstrating that infection can also occur in the fetus in utero.
Clinical manifestations.
The incubation period of the disease is 1-3 weeks, with an average of 2 weeks.
Men: The symptoms of non-gonococcal urethritis are less severe than gonorrhea, and the onset of the disease is less urgent than gonorrhea, with delayed and sometimes severe symptoms. There is a tingling or burning sensation in the urethra, and occasionally a stinging sensation. A small amount of secretion overflows only after a long period of time without urination or before the first urination in the morning, and sometimes it only shows as a scab film sealing the urethral orifice in the morning (in the form of a mucous paste, called a paste, and the scab film is easily washed off by the urine stream.) Or the crotch of the pants is contaminated and there is discharge attached. On examination, some patients need to press the anterior urethra from back to front before a little discharge may come out from the urethral orifice. Sometimes the patient may have symptoms without discharge, or may have discharge without symptoms. Sometimes the patient does not have any conscious symptoms. It is easy to miss the diagnosis at the first visit.
Women: Non-gonococcal urethritis is characterized by few or no symptoms. When infected with a UTI, about 50% have frequent urination, burning sensation in the urethra or difficulty in urination, and a little plasma-like or mucopurulent discharge can be found at the urethra, but there are usually no symptoms of painful urination or only mild painful urination. Sometimes there is also inflammation or erosion of the cervix, and the cervical discharge has a majority of lobulated leukocytes (more than 10 per field of view under high magnification). On examination, the cervix is found to be edematous and eroded, with increased leucorrhea, so it often causes vulvar or vaginal itching. In female patients with vestibular gland disease, the vestibular gland is enlarged with localized redness and may also form abscesses that require incision and drainage. Patients with combined tubitis, endometritis, and pelvic inflammatory disease will present with appropriate symptoms.
Clinical diagnosis.
Those with a history of impure intercourse, contact with infection, urethral and vaginal discharge and burning painful urination manifestations while excluding the possibility of infection by other pathogens, taking a smear of urethral or cervical discharge and seeing ≥5 polymorphonuclear leukocytes under a 1000x microscope can make a preliminary diagnosis. Next, laboratory diagnosis should be made, and the methods are.
1, mycoplasma culture.
a, collection of specimens, generally urogenital specimens or brushings, a few take prostatic fluid, semen, joint fluid, or take the fallopian tube, rectal biopsies, in recent years, with primary urine specimens centrifugal material, to replace the urethral swab. When swabbing, the swab is inserted into the male urethra 2-4 cm and taken by forceful rubbing. This method can easily cause urethral injury and secondary infection. It should be used with caution. In females, the cervical epithelium combined with squamous and columnar epithelium should be cleaned first, and the cervical specimen should be collected by cell brush, which can increase the number of infected cells and is more sensitive than cotton swab.
b. Commonly used medium is bovine heart dip or peptone, and contains 1% fresh yeast dip, 10-20% animal serum and 0.5% sodium chloride, also can add glucose and arginine to promote MH and MG growth, add urea for UU metabolism, moderate amount of penicillin to inhibit miscellaneous bacteria.
2.Serological identification method.
The most commonly used is the agar diffusion method, that is, the mycoplasma inoculated onto the agar dish. Then use the appropriate amount of serum soaked filter paper onto the surface of the agar, observe which can inhibit the growth of mycoplasma. This method has the advantage of using the colonies that initially grow on the agar surface without having to pass on the mycoplasma.
Serological diagnostic test: enzyme-linked immunosorbent assay (ELISA) is highly sensitive: microimmunofluorescence method (MIF) has rapid characteristics.
3. Genetic diagnosis.
The use of DNA probes for mycoplasma diagnosis its sensitivity is slightly poor, but high specificity, with polymerase chain reaction (PCR), sensitivity, specificity are high.
Treatment views.
1, with a more typical course of infection, regardless of the presence or absence of symptoms (because about half of those who belong to the symptoms are not obvious, until the obvious may have caused damage) check chlamydia positive people, regardless of sex need to be treated.
2, some people who do not have symptoms of urethritis at all accidental physical examination found, or some women found after pregnancy mycoplasma infection, but local examination without inflammatory manifestations, more likely to belong to the carrier, whether treatment has some differences. For ordinary people, no special treatment is needed, or after the regular use of antibiotics, it is better to turn negative, but not to turn negative is not necessary to force; for pregnant women, it is generally recommended to turn negative with drugs, but it is not necessary to be demanding.
3, medication, the current antibiotic resistance phenomenon is becoming more and more obvious, the types of resistance and drugs in each region are not quite the same, so there will be some people with Mymanomycin good, some people like to use Archie, and a study in Guangdong showed that cross-sampling is the most sensitive to Mycoplasma solium; but because of this, when a certain antibiotic is widely used, the chance of its resistance is greatly increased. The current combination of drugs is sometimes a last resort.
4, empirical use of drugs after a course of effect is not obvious, should be actively drug sensitivity test.
5, the combination of Chinese and Western medicine can improve the symptoms faster and also reduce the drug resistance to a certain extent, of course, this combination is not Chinese medicine plus Western medicine, but an organic combination.
Daily precautions.
1. Avoid sexual intercourse before the cure.
2, no alcohol, no spicy food, drink more water.
3, do the necessary isolation in the family, bath towels, washbasin, bathtub, commode, etc. are used separately, or disinfection after use.
4.Spouse or sexual partner should go to hospital for examination and treatment.
5. Pay attention to safe sex in the future, and use condoms correctly in high-risk cases.
Treatment of a small number of untreated patients.
A small number of people still have symptoms after regular treatment, or have recurrent UTIs. There are the following reasons.
1. inappropriate choice of therapeutic drugs, with drug-resistant strains of bacteria.
2. reinfection, with untreated sexual partners.
3, the patient did not use the medication as prescribed, drinking alcohol and spicy food can also affect the efficacy of drugs.
4, neglect of mixed infections, such as combined gonorrhea or trichomonas
5, certain bacterial infections leading to non-specific urethritis are ignored.
6. some symptoms are caused by combined prostatitis
7, inflammatory damage to the urethral mucosa such as edema, hyperplasia has not yet recovered, or local nerve strain, symptoms can occur, but will slowly improve without treatment.