Non-gonococcal urethritis

Overview Of Non-gonococcal urethritis

Non-gonococcal urethritis (NGU) is an inflammation of the urethra that is not caused by *Neisseria gonorrhoeae*, the bacterium responsible for gonorrhea. It is one of the most common sexually transmitted infections (STIs) and can affect both men and women, though it is more frequently diagnosed in men. NGU is typically caused by other pathogens, most commonly *Chlamydia trachomatis*, but also *Mycoplasma genitalium*, *Ureaplasma urealyticum*, and *Trichomonas vaginalis*. Symptoms include dysuria (painful urination), urethral discharge, and itching or irritation at the urethral opening. However, many cases are asymptomatic, particularly in women. If left untreated, NGU can lead to complications such as epididymitis in men and pelvic inflammatory disease (PID) in women. Early diagnosis and treatment are essential to prevent these outcomes.

Causes of Non-gonococcal urethritis

• The primary cause of non-gonococcal urethritis is infection with *Chlamydia trachomatis*, which accounts for approximately 30–50% of cases. Other pathogens include *Mycoplasma genitalium*, *Ureaplasma urealyticum*, and *Trichomonas vaginalis*. Less commonly, NGU can be caused by herpes simplex virus (HSV), adenovirus, or non-infectious factors such as trauma or chemical irritants. The infection is typically transmitted through unprotected sexual contact, including vaginal, anal, or oral sex. Risk factors include multiple sexual partners, a history of STIs, and lack of condom use. In some cases, the causative organism cannot be identified, and the condition is referred to as idiopathic urethritis.

Risk Factors of Non-gonococcal urethritis

• Several factors increase the risk of developing non-gonococcal urethritis. Unprotected sexual activity, including vaginal, anal, or oral sex, is the primary risk factor. Having multiple sexual partners or a new sexual partner within the past two months also elevates the risk. A history of sexually transmitted infections, particularly chlamydia or gonorrhea, increases susceptibility to NGU. Young age (under 25) is associated with higher risk due to increased sexual activity and potential lack of awareness about safe sex practices. Men who have sex with men (MSM) are at higher risk due to the potential for exposure to multiple pathogens. Socioeconomic factors, such as limited access to healthcare, can also contribute to delayed diagnosis and treatment.

Prevention of Non-gonococcal urethritis

• Preventing non-gonococcal urethritis involves adopting safe sexual practices and reducing exposure to risk factors. Consistent and correct use of condoms during vaginal, anal, and oral sex significantly reduces the risk of transmission. Limiting the number of sexual partners and avoiding sexual activity with individuals who have symptoms of STIs can also lower the risk. Regular screening for STIs, particularly for individuals with multiple partners or a history of STIs, is recommended. Early treatment of infections like chlamydia or trichomoniasis can prevent the development of NGU. Education and access to healthcare services are key components of prevention efforts.

Prognosis of Non-gonococcal urethritis

• The prognosis for non-gonococcal urethritis is generally good with appropriate treatment. Most patients experience symptom relief within a few days of starting antibiotics, and the infection is typically fully resolved within a week. However, untreated or inadequately treated NGU can lead to complications, such as epididymitis in men or pelvic inflammatory disease (PID) in women. Recurrent or persistent symptoms may occur, particularly if the causative organism is resistant to initial treatment or if reinfection occurs due to untreated sexual partners. Long-term outcomes are improved with early diagnosis, adherence to treatment, and addressing risk factors such as unprotected sex and multiple partners.

Complications of Non-gonococcal urethritis

• If left untreated, non-gonococcal urethritis can lead to several complications. In men, the infection can spread to the epididymis, causing epididymitis, which is characterized by testicular pain and swelling. In women, untreated NGU can progress to pelvic inflammatory disease (PID), leading to chronic pelvic pain, infertility, or ectopic pregnancy. Reactive arthritis, a condition characterized by joint inflammation, can occur in both men and women as a complication of NGU, particularly when caused by *Chlamydia trachomatis*. Rarely, untreated NGU can lead to systemic infections or abscesses. Prompt treatment and follow-up are essential to prevent these complications.

Related Diseases of Non-gonococcal urethritis

• Non-gonococcal urethritis is closely associated with several other sexually transmitted infections and conditions. Gonococcal urethritis, caused by *Neisseria gonorrhoeae*, shares similar symptoms but requires different treatment. Pelvic inflammatory disease (PID) in women and epididymitis in men are common complications of untreated NGU. Reactive arthritis, also known as Reiter’s syndrome, can occur as a systemic complication of NGU, particularly when caused by *Chlamydia trachomatis*. Other STIs, such as syphilis, herpes simplex virus (HSV), and human papillomavirus (HPV), may coexist with NGU and require comprehensive management. Understanding these related diseases is essential for accurate diagnosis and effective treatment.

Treatment of Non-gonococcal urethritis

The treatment of non-gonococcal urethritis typically involves antibiotic therapy to eradicate the causative pathogen. For *Chlamydia trachomatis*, the first-line treatment is a single dose of azithromycin or a 7-day course of doxycycline. For *Mycoplasma genitalium*, azithromycin or moxifloxacin may be used, depending on local resistance patterns. Metronidazole or tinidazole is effective for *Trichomonas vaginalis*. Sexual partners should be tested and treated to prevent reinfection. Patients are advised to abstain from sexual activity until treatment is completed and symptoms have resolved. Follow-up testing may be recommended to ensure the infection has been cleared, particularly in cases of persistent or recurrent symptoms.