Fluoroquinolones for the treatment of nongonococcal urethritis/cervicitis

Approximately 50% of cases of nongonococcal urethritis reported among men are caused by Chlamydia trachomatis. Other pathogens implicated in the bacterial etiology of nongonococcal urethritis that occur independently or concurrently with gonorrhea include Ureaplasma urealyticum and species of Mycoplasma, including Mycoplasma hominis. The etiology of up to half of the cases, however, remains uncertain. Historically, C. trachomatis genital infections have been difficult to diagnose because of the need for expensive cell-culture methods that are technically difficult and produce delayed results. In addition, women with nongonococcal cervicitis/mucopurulent cervicitis are frequently asymptomatic except for vaginal discharge. Nongonococcal urethritis may also be asymptomatic in men. Increased morbidity is associated with unidentified and untreated C. trachomatis infections, especially in women and children. Currently, the Centers for Disease Control recommends that all patients diagnosed with nongonococcal urethritis, nongonococcal cervicitis, or gonorrhea--along with their sexual partners--receive adequate antimicrobial therapy that includes antimicrobial activity against chlamydiae. A tetracycline antibiotic is most commonly recommended. However, tetracyclines have variable in vitro activity against U. urealyticum and Mycoplasma species. New antibiotic therapy options with broader antimicrobial coverage are needed for the management of nongonococcal urethritis and cervicitis.