Nongonococcal Urethritis

Urethritis (or in other words inflammation of urethra) is one of the most common sources of infection in adult men and women. It has been observed that most cases of urethritis in adults are caused by gonorrhea.

Nongonococcal urethritis (NGU) is the urethral infection that is caused by pathogens other than gonorrhea.

What Are Some Common Pathogens That May Cause NGU?

Besides gonorrhea, other common sources of nongonococcal urethritis are:

• Haemophilus vaginalis
• Ureaplasma urealyticum
• Chlamydia trachomatis
• Adenovirus
• Mycoplasma genitalium
• Trichomonas vaginalis
• Herpes simplex virus (HVS)

Among these pathogens, the most common causative microorganism is Chlamydia whereas HVS and Trichomonas vaginalis rarely induce NGU.

Transmission Of Nongonococcal Urethritis

Nongonococcal urethritis can be transmitted sexually as well as via non-sexual contact.

• Sexual Transmission:

Infection can spread through all forms of sexual contact whether it is anal, vaginal, or oral. The infectious agents may even spread if penis or tongue is not fully penetrated into the body cavities. A direct contact of infected person with the

mucus membrane of healthy individual is enough for the transmission of infection.

• Non- Sexual Transmission:

The non-sexual ways of transmission are:

• Bacterial prostatitis
• Urethral stricture (closed or narrowed penile tube)
• Urinary tract infections
• Phimosa (tightened foreskin, unable to retract)
• Procedures that involves insertion of catheter inside penis

These pathogens may also transmit from mother to child during birth while passing through the infected birth canal. This perinatal exposure may cause conjunctivitis, pneumonia, and ear infections.

What Are Classic Symptoms Of NGU?

NGU exhibits different symptoms in both men and women due to difference in anatomical characteristics.

In men nongonococcal urethritis may cause:

• Urination with pain or burning sensation
• Penile discharge
• Itching and irritation in penis
• Tenderness
• Stained underpants

In women, the same microbes that causes NGU in men may cause other infections including, mucopurulent cervicitis (MPC) or vaginitis. Some women may not exhibit any symptoms at all. However, possible symptoms include:

• Vaginal discharge
• Painful urination
• Urination with burning sensation
• Unusual vaginal bleeding or abdominal pain may be an indication that infection has advanced to pelvic inflammatory disease (PID).

The oral infections are usually asymptomatic but some might experience sore throat. While anal infections are characterized by itching in rectum or painful excretion.

Diagnosis

In men, nongonococcal urethritis is diagnosed when person complaints of urethritis symptoms but culture results are negative for gonorrhea. Other diagnostic tests include urine screening and culture test for chlamydia which are rarely done. While in women culture test for chlamydia is performed for the diagnosis. To exclude doubt for gonorrhea, culture test for gonorrhea should also be performed.

Treatment Of NGU

• NGU is mainly treated with azithromycin and doxycycline but, ofloxacin and erythromycin can be advised as an alternative option.
• For persistent or repeated urethritis, metronidazole along with erythromycin is recommended.
• A pregnant woman or a woman planning to conceive should tell the physician about it. Also, more caution must be maintained while making a decision about the medications.
• It is important to inform your sexual partner(s) and get them tested as well. Infected person should restrain from all sexual activities until treatment is completed and all symptoms are gone.

Complications Associated With NGU

NGU, especially if caused by Chlamydia can lead to numerous complications, if left untreated. The complications are different for men and women but infection due to anal sex may cause severe proctitis in both.

In men:

• Skin lesions
• Conjunctivitis
• Reiter’s syndrome (arthritis)
• Discharge
• Epididymitis (untreated epididymitis may lead to infertility)

In women:

• Pelvic inflammatory disease which may lead to ectopic pregnancy
• Repetitive PID which may cause infertility
• Miscarriage
• chronic pelvic pain
• Mucopurulent cervicitis (MPC)
• Vaginitis
• Urethritis

References

• Takahashi, S., Hamasuna, R., Yasuda, M., Ito, S., Ito, K., Kawai, S., ... & Suzuki, N. (2013). Clinical efficacy of sitafloxacin 100 mg twice daily for 7 days for patients with non-gonococcal urethritis. Journal of Infection and Chemotherapy, 19(5), 941-945.
• Rane, V. S., Fairley, C. K., Weerakoon, A., Read, T. H., Fehler, G., Chen, M. Y., & Bradshaw, C. S. (2014). Characteristics of acute nongonococcal urethritis in men differ by sexual preference. Journal of clinical microbiology, 52(8), 2971-2976.
• Frølund, M., Lidbrink, P., Wikström, A., Cowan, S., Ahrens, P., & Jensen, J. S. (2016). Urethritis-associated Pathogens in Urine from Men with Non-gonococcal Urethritis: A Case-control Study. Acta Derm Venereol, 96, 689-694.