Overview of non-gonococcal urethritis
Non-gonococcal urethritis is an infection caused by pathogens other than gonococcus.
It is characterized by painful urination and increased urethral discharge.
Caused by pathogens other than gonococcus.
Mainly treated with medication
Definition
Non-gonococcal urethritis (NGU) refers to urethritis caused by pathogens other than gonococcus, which is characterized by the presence of urethritis but the absence of gonococcus in urethral discharge.
The common pathogenic microorganisms of nongonococcal urethritis are Chlamydia trachomatis, followed by Mycoplasma genitalium and Mycoplasma detritis. Trichomonas vaginalis and herpes simplex virus can also cause it.
Types
Male non-gonococcal urethritis: common symptoms are itching and burning sensation in the urethra. 20% to 50% of male patients may be asymptomatic.
Non-gonococcal urethritis in females: the clinical symptoms in females are less typical than in males and mainly involve the cervix. 70% of females have no symptoms or the symptoms are very mild and do not attract the patient’s attention.
Morbidity
The prevalence of non-gonococcal urethritis is high, and it is the most common among sexually transmitted diseases.
It occurs in the age groups of 20 to 24 years old and 25 to 30 years old.
Both men and women are affected, with women reported to be more common than men (5.9:3.3), but men are reported to be more common than women in China.
Among them, 11% to 50% are infected with Chlamydia trachomatis, 6% to 50% with Mycoplasma genitalium, and 11% to 26% with Mycoplasma hyopneumoniae.
Causes
Causes
Infectious agents
Patients with nongonococcal urethritis or those with latent infection are the main source of infection.
Route of transmission
Sexual contact
Sexual contact is the main mode of transmission.
The pathogenic bacteria invade the epithelial cells of the urethral mucosa through vaginal and anal intercourse, causing the urethral mucosa to become infected and cause nongonococcal urethritis.
Indirect contact
Patients can discharge secretions with mycoplasma and chlamydia, which are infectious.
Sharing personal items such as towels, washcloths, toothbrushes, etc. with patients may be infectious.
Contact in daily life and at work is generally not contagious.
Vertical transmission from mother to child
If the mother has nongonococcal urethritis, the fetus can be infected by passing through the infected birth canal during delivery or by close contact with the mother after birth, but it will not cause neonatal urethritis.
Susceptible People
All people can get nongonococcal urethritis. The following groups of people are more susceptible than the general population:
People who have multiple sexual partners and frequent sexual intercourse.
People with a history of sexual misconduct.
People who are immunocompromised.
Risk factors
High-risk sexual behavior
For example, multiple sexual partners, unprotected intercourse, etc. can increase the incidence and recurrence of nongonococcal urethritis.
Low immunity
When the body’s resistance is low, the defense against pathogens is weakened. For example, Trichomonas vaginalis is more likely to be infected in immunocompromised people.
Other factors
After menopause, estrogen production decreases in women, causing changes in the urethra that make it more susceptible to infection.
Combined gonorrhea infection.
Symptoms
Main manifestations
Non-gonococcal urethritis usually develops 1 to 5 weeks after infection. Some patients may have no obvious symptoms, or the symptoms are very mild and fail to attract patients’ attention. The main symptoms include painful urination and increased urethral discharge. Symptoms differ between male and female patients.
Male non-gonococcal urethritis
Tingling, stinging or burning sensation at the urethra.
Urgency and difficulty in urination.
Slight redness and swelling of the urethral opening and a small amount of thin, syrupy discharge.
Urethral discharge may form a crust that seals the urethral opening or contaminates the underwear before the first urination in the morning or after a long period of time without urination.
Non-gonococcal urethritis in women
Increased vaginal discharge.
Vulvar discomfort.
Lower abdominal pain.
Urgency, frequency, and difficulty urinating.
No urinary pain or only slight urinary pain.
Other manifestations
Some men may experience localized pain in the penis.
Some women may experience non-menstrual or post-coital bleeding.
Complications
Non-gonococcal urethritis in men
Prostatitis: the main symptom is discomfort in urination, acute stage of urination with more intense pain, which may radiate to the scrotum and buttocks, a few accompanied by fever or general discomfort.
The most important thing to remember is that it is not a good idea to have a good time, but it is a good idea to have a good time.
Epididymitis: the main manifestation of the epididymis is large, tenderness, the vas deferens is often thickened, pain, may be accompanied by scrotal edema.
Proctitis: mainly manifested as anal pain, itching and increased secretion.
Adult inclusion body conjunctivitis: manifested as mild or moderate eye redness, eye irritation, eyelid swelling and significant conjunctival congestion.
Infertility: partner is not pregnant after 1 year of normal uncontraceptive sex.
Female non-gonococcal urethritis
Pelvic inflammatory disease: acute onset of systemic symptoms is obvious, manifested as fever, lack of appetite and nausea and vomiting and other digestive symptoms, lower abdominal pain is severe. Chronic onset of the disease is mainly manifested as increased leukorrhea, lower abdominal distension, lumbar pain and menstrual irregularities.
Endometritis: manifested by increased menstrual flow, prolonged or shortened menstrual period and lower abdominal pain.
Tubal infection: clinical symptoms are mild, mainly manifested as lower abdominal pain.
Perinatal infection: about 37% of pregnant women infected by Chlamydia trachomatis may develop postpartum pelvic infection, which may also cause amnionitis, leading to preterm labor and stillbirth.
Vestibular adenitis: redness, swelling and pain at the opening of the vestibular gland, abscess can be formed in severe cases, and chronic recurrent episodes can form vestibular cysts.
Perihepatitis: manifested by fever, pain in the liver area and pelvic pain.
Consultation
Department of Medicine
Urology
Presence of urinary pain, urgency, frequency, difficulty in urination, accompanied by urethral urethral erythema and abnormal discharge from the urethral orifice, it is recommended to consult a doctor in time.
Gynecology
Women may have increased vaginal discharge in addition to urinary tract symptoms, prompt medical attention is recommended.
Dermatology and Venereology
Patients may have high-risk sexual behaviors and develop urinary tract symptoms, prompt medical attention is recommended.
Preparation for medical treatment
Consultation: Registration, Preparation of documents, Frequently Asked Questions
Tips for seeking medical treatment
If there is redness, swelling and pain in the urethra before consultation, it is recommended to apply cold saline compresses to the red and swollen areas, and to avoid self-application of externally purchased medications to avoid aggravating the condition or affecting the assessment of the disease.
If there is pus discharge from the urethra, do not wash it deliberately before consultation.
If your sexual partner has similar symptoms, it is recommended to consult the doctor together.
Preparation Checklist
Symptom checklist
Particular attention needs to be paid to the time of onset of symptoms, specific manifestations, etc.
When did the symptoms of painful urination, urgency and frequency appear?
Is there any redness, swelling or discharge from the urethra? Is the discharge purulent or thin?
Are the symptoms persistent or recurrent?
Medical History Checklist
Does the sexual partner have a similar condition? Is there a history of impure sex?
Is there any comorbidity with other urologic conditions?
Any history of allergies to food, drugs and other substances?
Checklist
Test results of the past 1 week, which can be brought to the doctor’s office
Urine sediment test
Gram-stained smear of local secretion, Mycoplasma, Chlamydia fluorescence test, PCR test or pathogen culture
Medication list
Medication for the past 3 months, if available in boxes or packages, bring with you to the doctor’s office
Antimicrobials (oral or injectable): erythromycin, roxithromycin, azithromycin, minocycline, doxycycline, levofloxacin, ciprofloxacin, ceftriaxone
Disinfectants (topical): povidone-iodine, povidone-iodine, isacridine lactate
Diagnosis
Diagnosis is based on
Medical history
Have multiple sexual partners or frequent sexual behavior.
History of impure sex.
Clinical manifestations
Symptoms
Painful urination, urinary urgency, frequent urination, difficulty in urination.
Women may be accompanied by increased vaginal discharge.
In men, the urethral opening is red and swollen with abnormal discharge.
Physical signs
Female: cervical congestion with purulent discharge from the cervical opening.
Male: slight redness and swelling of the urethral opening with a small amount of thin, syrupy discharge.
Laboratory Tests
Blood tests
An elevated peripheral blood leukocyte count and neutrophil count may confirm the presence of an inflammatory response.
Smear of urethral secretion
Gram staining of urethral secretions, a certain number of characteristic Chlamydia trachomatis inclusion bodies can be seen to make the diagnosis.
Direct fluorescent antibody assay
Detection of Chlamydia trachomatis antigen by fluorescent antibody.
It is a simple method with high specificity and sensitivity, and the sensitivity is 68%-100% and the specificity is 80%-95%.
Polymerase Chain Reaction (PCR)
Detects the DNA of pathogens to clarify the type of infecting pathogen.
Enzyme immunoassay
Using enzyme immunoassay to detect chlamydial antibodies in patients’ genitourinary tract specimens, the sensitivity is 60% to 90% and the specificity is 92% to 97%.
It is currently a common clinical method used to detect Chlamydia trachomatis infection in the genitourinary tract.
Differential diagnosis
Gonorrhea
Similarity: both can have painful urination and difficulty in urination.
Differences: Gonorrhea is caused by gonococcal infection, the incubation period is 3 to 5 days, urinary pain and dysuria are more serious, and the urethral discharge is purulent. Pathogen examination can clarify the diagnosis.
Cystitis
Similarities: both can have symptoms such as frequent urination, urgency, and painful urination.
Differences: cystitis above symptoms are more obvious, may have pus or terminal hematuria, can be distinguished by cystoscopy.
Acute prostatitis
Similarities: both may have frequent, urgent, painful urination.
Difference: Rectal palpation of acute prostatitis can feel the enlarged prostate with obvious pressure pain.
Bladder cancer
Similarity: both may have frequent urination, urgency of urination.
Difference: bladder cancer can have painless hematuria, which can be differentiated by cystoscopic histopathological examination.
Urethral syndrome
Similarity: both may have urinary frequency, urgency, urinary pain and urinary discomfort.
Difference: Urethral syndrome has no true bacteriuria in multiple examinations.
Treatment
The treatment of nongonococcal urethritis is aimed at blocking transmission, avoiding aggravation of self-infection and preventing complications.
Medication
Individual medications
Tetracyclines
Effects: inhibit the growth of pathogens by inhibiting their protein synthesis, high concentration has bactericidal effect, effective against Chlamydia trachomatis and Mycoplasma.
Commonly used drugs: tetracycline hydrochloride, doxycycline, minocycline.
Adverse reactions: nausea, vomiting, diarrhea, and epigastric discomfort.
Macrolides
Application: contraindication or intolerance to tetracycline, effective against Chlamydia trachomatis and Mycoplasma urealyticum.
Commonly used drugs: erythromycin, roxithromycin, azithromycin.
Quinolones
Effects: By inhibiting the DNA helicase of pathogens, interfering with DNA synthesis and causing the death of pathogens, with the advantages of strong, long-lasting and not easy to produce drug resistance.
Commonly used drugs: ofloxacin, ciprofloxacin.
Combination of drugs
The combination of ceftriaxone and doxycycline is recommended for the treatment of nongonococcal urethritis and gonorrhea.
Treatment of special populations
Pregnant women should not be treated with tetracyclines and quinolones, but can choose erythromycin, erythromycin succinate, azithromycin and other antibacterial drugs.
Newborns can be infected with Chlamydia trachomatis through the birth canal to cause conjunctivitis, and erythromycin dry syrup powder can be used orally for 2 weeks.
Sexual partners should all be examined and treated at the same time, the treatment program is the same as above.
Medication precautions
The doctor will formulate an appropriate treatment plan according to the specific condition and laboratory test results, please make sure to follow the doctor’s instructions to take the medicine.
If any adverse reaction occurs during treatment, please inform your doctor promptly.
Avoid sexual intercourse during treatment.
Traditional Chinese Medicine (TCM)
Chinese medicines, such as Huangbai, Angelica dahurica, Dibotryon and Rhubarb, are effective in the treatment of non-gonococcal urethritis, but please consult with your TCM doctor for the specific use of these medicines, and do not listen to “biased prescriptions” or “local remedies”.
Prognosis
Cure
After timely and regular treatment, the prognosis is good and can be cured.
50% to 70% of male patients can be cured within 1 to 3 months without treatment.
About 20% of the patients have persistent or recurrent symptoms after treatment, which may be due to untreated sexual partners, poor adherence to treatment, drug resistance of pathogens, and reinfection.
Hazards
Infection of the newborn
If the mother is ill and the causative agent that causes nongonococcal urethritis is present in the birth canal, the newborn may become infected during delivery through the mother’s birth canal, causing neonatal conjunctivitis or pneumonia.
Affecting the mind
The area where the symptoms of nongonococcal urethritis appear is relatively private, which can easily affect the state of mind, resulting in low self-esteem.
Causes many complications
Men with nongonococcal urethritis may suffer from prostatitis, seminal vesiculitis, epididymitis, Reiter’s syndrome and other complications.
Women may develop complications such as pelvic inflammatory disease, endometritis, and salpingitis.
In severe cases, this can lead to infertility.
Daily
Daily Management
Dietary management
Treatment period
Diet should be light, abstaining from spicy and fishy stimulating foods, such as chili peppers, mace, coffee, fish, shrimp and crab.
Abstain from alcohol.
Supplement more high-quality protein, such as soymilk, tofu, milk, eggs, lean meat and fresh fruits and vegetables to promote wound healing.
Drink more water to dilute urine and reduce irritation, and do not have the habit of holding urine.
Recovery period
No special contraindications, normal healthy diet is sufficient.
Life management
Pay attention to local skin hygiene and dryness.
Change underwear frequently and wear loose cotton underwear.
It is best to hand wash underwear with mild soap, do not use strong laundry detergent or liquid laundry detergent.
Do not share cleaning and washing utensils with others, and keep towels and clothes separate.
Keep a regular schedule and avoid staying up late.
Quit smoking.
After urination and defecation, you should wipe from front to back to help prevent bacteria around the anus from spreading to the vagina and urethra.
Choose suitable aerobic exercise (jogging, brisk walking, tai chi, yoga, etc.) during the day.
Psychological support
You can relax your body and mind and relieve tension by listening to soft music, taking deep breaths and watching entertainment programs.
Be sure to maintain an optimistic mindset and have confidence in overcoming the disease. Family members should encourage and support the patient.
Prevention
Avoid unsafe sex.
When having sex, using condoms can reduce the risk of reproductive tract infections.
Do not share personal items such as underwear, swimwear, slippers and towels with others.
Wear loose, comfortable underwear and not tight pants to reduce irritation of the vulva.
Women should avoid excessive vaginal douching.
Exercise appropriately and choose activities suitable for you, jogging, cycling, etc., which can improve your body’s resistance.
Adopt good living habits, ensure sufficient sleep, and pay attention to the combination of work and rest.