NON-GONOCOCCAL
URETHRITIS
(NGU)
nPGU, a special variant of NGU, is seen in men who have been successfully treated for gonococcal infection and either develop symptoms shortly after therapy or remain asymptomatic.
nC. trachomatis is responsible for 70% to 90% of cases.
nBeta-lactum drugs used to treat gonorrhea are largely ineffective against Chlamydia.
nBecause of the high (>20%) double infection rate, CDC and WHO recommend that all cases of gonorrhea be treated presumptively for chlamydial infection.
àChlamydia tracomatis 50%
à‘Non-specific’ 30%
àOther causes 20%
Ureaplasm urealyticum.
Mycoplasma genitalium.
Trichomonas vaginalis.
Candida albicans.
Herpes simplex virus.
Urinary tract infection.
Urethral stricture, Foreign bodies
and associated with Reiter’s diseases.
1. Erythromycin 500 mg orally 6-hourly
for 14 days.
PLUS
2. Metronidazole 400 mg orally 12-hourly
for 5 days.
Urethritis with an identified pathogen (except gonococcus) is called NGU.
NGU is diagnosed by exclusion, that is, failure to find Neisseria gonorrhoeae in urethral specimen from a man with urethritis.
Urethritis with unidentified pathogen is called NSU.
NGU is diagnosed by exclusion, that is, failure to find Neisseria gonorrhoeae in urethral specimen from a man with urethritis.
Urethritis with unidentified pathogen is called NSU.
NGU, in male, is characterized by:
1. Painful micturation (dysuria),
2. Frequency of micturation and
3. A scanty mucoid or mucopurulent
urethral discharge.
4. It has a long incubation period and
5. It has a less acute onset.
1. Painful micturation (dysuria),
2. Frequency of micturation and
3. A scanty mucoid or mucopurulent
urethral discharge.
4. It has a long incubation period and
5. It has a less acute onset.
NON-GONOCOCCAL URETHRITIS
(NGU) IN FEMALE
(NGU) IN FEMALE
nNGU, in female, mostly asymptomatic, in about 80% cases or associated with vaginal discharge and/or painful micturation.
nPost-coitus or intermenstrual bleeding may be a presenting features.
nExamination may reveal mucopurulant cervicitis, contact bleeding from cervix, evidences of PID or no obvious cause.
nPost-coitus or intermenstrual bleeding may be a presenting features.
nExamination may reveal mucopurulant cervicitis, contact bleeding from cervix, evidences of PID or no obvious cause.
nPGU, a special variant of NGU, is seen in men who have been successfully treated for gonococcal infection and either develop symptoms shortly after therapy or remain asymptomatic.
nC. trachomatis is responsible for 70% to 90% of cases.
nBeta-lactum drugs used to treat gonorrhea are largely ineffective against Chlamydia.
nBecause of the high (>20%) double infection rate, CDC and WHO recommend that all cases of gonorrhea be treated presumptively for chlamydial infection.
EPIDEMIOLOGY OF NGU
NGU patients are:
nmore often white, better educated,
nmore likely to be students and less likely to be unemployed,
nmembers of the higher socioeconomic status,
nolder at the age of first intercourse and
nhas fewer sex partners.
nmore often white, better educated,
nmore likely to be students and less likely to be unemployed,
nmembers of the higher socioeconomic status,
nolder at the age of first intercourse and
nhas fewer sex partners.
Causes of NGU
àChlamydia tracomatis 50%
à‘Non-specific’ 30%
àOther causes 20%
Ureaplasm urealyticum.
Mycoplasma genitalium.
Trichomonas vaginalis.
Candida albicans.
Herpes simplex virus.
Urinary tract infection.
Urethral stricture, Foreign bodies
and associated with Reiter’s diseases.
Complications of NGU
In male:
Epididymo-orchitis.
In female:
Cervicitis may lead to-
PID: (lower abdominal pain, dyspareunia
& post-coital or intermenstrual bleeding).
Cervical neoplasia.
Adverse pregnancy outcome: (tubal damage
leading to infertility or ectopic pregnancy).
Epididymo-orchitis.
In female:
Cervicitis may lead to-
PID: (lower abdominal pain, dyspareunia
& post-coital or intermenstrual bleeding).
Cervical neoplasia.
Adverse pregnancy outcome: (tubal damage
leading to infertility or ectopic pregnancy).
In both sexes:
nSexually acquired reactive arthropathy
(SARA).
nReiter’s syndrome
(tried of urethritis, conjunctivitis & arthritis).
nOphthalmia neonatorum.
nConjunctivitis in adult.
nSexually acquired reactive arthropathy
(SARA).
nReiter’s syndrome
(tried of urethritis, conjunctivitis & arthritis).
nOphthalmia neonatorum.
nConjunctivitis in adult.
TREATMENT OF CHLAMYDIAL INFECTION AND NGU
STANDARD REGIMENS
Doxycycline 100 mg 12-hourly orally for 7 days or
Azithromycin 1 gm orally as a single dose.
ALTENATIVE REGIMENS
Erythromycin 500 mg 6-hourly orally for 7 days or
500 mg 12-hourly for 14 days or
Ofloxacin 200 mg 12-hourly orally for 7 days.
Doxycycline 100 mg 12-hourly orally for 7 days or
Azithromycin 1 gm orally as a single dose.
ALTENATIVE REGIMENS
Erythromycin 500 mg 6-hourly orally for 7 days or
500 mg 12-hourly for 14 days or
Ofloxacin 200 mg 12-hourly orally for 7 days.
1. Erythromycin 500 mg orally 6-hourly
for 14 days.
PLUS
2. Metronidazole 400 mg orally 12-hourly
for 5 days.
