NONGOOCOCCAL

URETHRITIS (NGU)
R.Varidianto Yudo T., dr

Nongonococcal urethritis (NGU) also known as non
specific urethritis (NSU), refers to any inflammation of
the urethra not caused by Neisseria gonorrhoeae
Sysmptom include painful urination and a watery
discharge
The most common pathogen associated with NGU is
Chlamydia trachomatis.
Many people suffering from gonorrhea are coinfected
with C.trachomatis, which infects the same columnar
epithelial cells as the gonococcus.
C.trachomatis is also responsible for the STD
lymphogranuloma venereum and trachoma.
This is the most common sexually transmitted
pathogen in the United States, responsible for an
estimated 3 to 4 million cases of NGU annually.
Of special importance is the fact that five times
as many cases are reported in females than
males.
In woman, it is responsible for many cases of pelvic
inflammatory disease, plus eye infections and
pneumonia in infants born to infected mothers.
Genital chlamydial infections are also associated with
an increased risk of cervical cancer.
It is uncertain whether chlamydial infection is an
independent factor in this risk or whether it is
associated with coinfections with human papillomavirus

Because the symptoms are often mild in males
and because females are usually asymptomatic,
many cases of NGU go untreated.
Although complications are not common, they
can be serious.
Males may develop inflammation of the
epididymis.
In females, inflammation of the uterine tubes
may cause sterility by scarring the tubes.
As many as 60% of such cases may be from
chlamydial rather than gonococcal infection.
It is estimated that about 50% of men and 70%
of women are unaware of their chlamydial
infection.
For diagnosis, culturing is the most reliable
method, but this requires specialized cultivation
methods, takes 24 to 72 hours, and is not always
conveniently available.
There are a number of new non-culture-based
tests available.
Several of them amplify and detect DNA or
RNA sequences of C.trachornatis.
These amplification tests can be done quickly
and are very sensitive, in the rank of 80 to 91%;
their specificity is close to 100%.
They are, however, relatively expensive and
require a laboratory with specialized equipment.
Urine samples can be used, bur the sensitivity is lower
then with swabs.
The most recent development in amplification testing is
to use swab specimens (urerhral or vaginal, as the case
might be) collected by the patient themselves which
they tend to prefer.
In view of the serious complications often associated
with infections by C.trachomatis, it is recommended that
physicians routinely screen sexually active women 25
years of age and younger for infection.
Screening is also recommended for other higher-risk
groups, such as persons who are unmarried, had a prior
risk of STDs, and have multiple sexual partners.
Bacteria other than C.trachomatis can also be implicated
in NGU.
Another cause of urethritis and infertility is Ureaplasrna
urealyticum.
This pathogen is a member of the mycoplasma
(bacteria without a cell wall).
Another mycoplasma, Mycoplasma hominis,
commonly inhabits the normal vagina but can
opportunistically cause uterine tube infection.
Both chlamydia and mycoplasma are sensitive to
tetracycline-type antibiotics such as doxycycline,
macrolide-type antibiotics such as azithromycin.

Referrences
Microbiology an Introduction 9
th
ed.; Tortora,
Funke, Case