Overview.
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 mycoplasmas (with at least three serotypes) are of the genus 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.
The newborn can be infected by pregnant women with chlamydia and mycoplasma during delivery. The transmission route: ① direct sexual contact infection, with patients suffering from non-gonococcal urethritis during sexual intercourse. (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 with the fetal membranes intact, thus demonstrating that infection can 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 that of gonorrhea, with delayed, sometimes mild and sometimes severe symptoms. There is a tingling or burning sensation in the urethra, and occasionally a stinging sensation. There is discharge from the urethra, but it is thinner than that of gonorrhea, and is clear and watery mucus-like or yellowish mucous-purulent, and the amount of discharge is less than that of gonorrhea. 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 away 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 tubal inflammation, 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 fallopian tubes, rectal biopsies, in recent years, with primary urine specimens centrifuged 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 women, the combined squamous and columnar epithelium of the cervix should be cleaned first, and the cervical specimen should be collected with a cell brush, which can increase the number of infected cells and is more sensitive than cotton swabs.
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 the growth of MH and MG, add urea for UU metabolism, appropriate 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 tests: enzyme-linked immunosorbent assay (ELISA) is highly sensitive: microimmunofluorescence (MIF) has rapid characteristics.
3. genetic diagnosis: using DNA probes for mycoplasma diagnosis its sensitivity is slightly poor, but the specificity is high, with polymerase chain reaction (PCR), sensitivity and specificity are high.
Treatment views.
1. those with a more typical course of infection, with or without symptoms (because about half of them belong to those with no obvious symptoms, and by the time they become obvious they may have already caused damage) who test positive for Chlamydia need treatment, regardless of gender.
2. Some people who have no symptoms of UTI at all are found by accidental physical examination, or some women are found to have mycoplasma infection after pregnancy, but there is no inflammatory manifestation in local examination, they are more likely to be carriers, and there is some difference in whether to treat them. For ordinary people, no special treatment is needed, or after regular use of antibiotics, it is better to turn negative, but not to force; for pregnant women, it is generally recommended to turn negative with medication, but it is not necessary to be demanding.
3. In terms of medication, the phenomenon of antibiotic resistance is becoming more and more obvious, and the types of resistance and drugs are not quite the same in each region, so there will be some people who are good with memantin and others who prefer to use Archie, while a study in a place in Guangdong showed that cross-samplex is the most sensitive to Mycoplasma solium; but because of this, when a certain antibiotic is widely used, the chance of its resistance increases greatly. The current combination of drugs is sometimes a last resort.
4. empirical medication is not effective after a course of treatment, should actively conduct drug sensitivity tests.
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 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 disinfected 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. This is because of the following reasons: 1. inappropriate choice of therapeutic drugs, with drug-resistant strains; 2. reinfection, with untreated sexual partners; 3. patients do not take medication as prescribed, and alcohol consumption and spicy food can also affect the efficacy of medication; 4. neglect of mixed infections, such as combined gonorrhea or trichomonas; 5. certain bacterial infections leading to non-specific UTIs are ignored; 6. some symptoms are caused by combined prostatitis; 7. urethral mucosa Inflammatory damage such as edema, hyperplasia that has not yet recovered, or local nerve strain can be symptomatic, but will slowly improve without treatment.