Management of non-gonococcal urethritis.
Harald Moi1, Karla Blee2, Patrick J Horner3
1Olafia Clinic, Oslo University Hospital, Institute of Medicine, University of Oslo, Oslo, Norway. harald.moi@medisin.uio.no.
BMC Infectious Diseases
|July 30, 2015
Summary
Non-gonococcal urethritis (NGU) is a common sexually transmitted infection in men. Early diagnosis and appropriate treatment, considering potential antimicrobial resistance, are crucial for effective management and preventing recurrence.
Area of Science:
- Urology
- Infectious Diseases
- Microbiology
Background:
- Non-gonococcal urethritis (NGU) is the most common treatable sexually transmitted syndrome in men.
- Key causative agents include Chlamydia trachomatis and Mycoplasma genitalium, with other potential pathogens like Ureaplasma urealyticum, Trichomonas vaginalis, viruses, and anaerobes.
- NGU can present with symptoms like discharge and dysuria, or be asymptomatic, with diagnosis confirmed by microscopy and nucleic acid amplification tests (NAAT).
Purpose of the Study:
- To outline diagnostic approaches for NGU, emphasizing the importance of ruling out gonorrhea.
- To discuss current treatment guidelines for NGU, including first-line options and management of persistent or recurrent cases.
- To highlight the implications of antimicrobial resistance, particularly with macrolide-resistant Mycoplasma genitalium, and the need for test-of-cure.
Main Methods:
- Microscopic examination of stained urethral smears to identify polymorpho-nuclear leucocytes (PMNLs) and rule out gonorrhea.
- Nucleic acid amplification tests (NAAT) for common pathogens like Neisseria gonorrhoeae, Chlamydia trachomatis, and Mycoplasma genitalium.
- Syndromic management with initial antibiotic treatment based on clinical presentation while awaiting laboratory results.
Main Results:
- Treatment options include doxycycline or azithromycin, with specific regimens for confirmed Mycoplasma genitalium infections.
- Management of macrolide-resistant Mycoplasma genitalium necessitates a test-of-cure and potential use of moxifloxacin.
- Guidelines suggest specific second-line treatments involving combinations of azithromycin, metronidazole, or doxycycline for persistent or recurrent NGU.
Conclusions:
- Prompt diagnosis and appropriate syndromic treatment are vital for managing NGU.
- Careful consideration of antimicrobial resistance patterns, especially for Mycoplasma genitalium, is essential for effective treatment and public health.
- Partner notification and treatment are critical components of NGU management to prevent reinfection.
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