Cases Of Nongonococcal Urethritis Research Articles

Molecular detection of Mycoplasma genitalium in men and pregnant women

Mycoplasma genitalium is an opportunistic pathogen of the genital tract. It has been implicated as an etiological agent of urethritis in men and cervicitis and pelvic inflammatory disease (PID) in women. The aim of this study was to determine the prevalence of Mycoplasma genitalium in male urethritis and in vaginal specimens of pregnant women. Urethral specimens obtained from 37 men presenting with urethritis and vaginal specimens from 50 consecutive pregnant women were tested for the presence of M. genitalium by polymerase chain reaction (PCR). The urethral specimens were also examined for the presence of Neisseria gonorrhoeae, Chlamydia trachomatis and Ureaplasma sp whereas the vaginal microbiota and the presence of genital mycoplasma were investigated in the vaginal specimens. Twenty three cases were classified as nongonococcal urethritis (NGU) and 14 as gonorrheal disease. M. genitalium was detected in 3 of 23 (13.04%) men with NGU; in two cases with Ureaplasma sp, and in one patient as the unique agent. C. trachomatis was found in 7 patients with NGU and in one patient with gonorrhea. Ureaplasma sp was isolated in 13 (35.1%) patients, 8 cases of NGU and in 5 patients with gonorrhea. The organism was also detected in 6 (15%) of 40 women; in 5 cases in the presence of a normal microbiota (Nugent score 0-3), and an in one case in the presence of bacterial vaginosis. Ureaplasma spp was isolated in the 6 positive specimens. This study indicates that M. genitalium can be detected in urethral specimens of some cases of NGU as well as in the lower genital tract of pregnant women in the presence of a normal vaginal microbiota.

The value of testing urine in non-gonococcal urethritis

This audit was conducted to look into the necessity of testing urine threads, in the diagnosis of non-gonococcal urethritis (NGU). In a sample of 280 NGU cases, it was found that in 8.8% of cases there was a risk of the diagnosis being missed, should Gram-stained urethral smears be totally relied on. The study showed that examining urine threads is beneficial in diagnosing NGU, especially, in symptomatic men with negative Gram-stained urethral smears. It should be noted, however, that in the group of patients studied for this audit, urine threads testing did not detect any chlamydia-positive NGU cases.

Mycoplasma genitalium urethritis in men

Mycoplasma genitalium was first isolated from two men with non-gonococcal urethritis (NGU) and thereafter shown to produce urethritis in subhuman primates, inoculated intraurethrally. This mycoplasma has been detected significantly more often in patients with acute NGU, particularly in patients with non-chlamydial NGU, than in subjects without urethritis. The prevalence of M. genitalium-positive non-chlamydial NGU ranges from 18 to 46% of all non-chlamydial NGU cases. In addition, the persistence of M. genitalium in the urethra after antimicrobial chemotherapy is associated with persistence or recurrence of NGU. The various results reported to date tend to support the proposition that M. genitalium is a pathogen of NGU. M. genitalium is highly susceptible to tetracyclines, macrolides, and some new fluoroquinolones, but the clinical data on the chemotherapy in M. genitalium-positive NGU is extremely limited. Because of the possible association between the post-treatment presence of M. genitalium in the urethra and persistent or recurrent NGU, the eradication of this mycoplasma from the urethra is essential in the management of patients with M. genitalium-positive NGU. Further studies are required to establish the optimal chemotherapy for M. genitalium-positive NGU.

Evaluation of extracts of Anthocleista djalonensis, Nauclea latifolia and Uvaria afzalii for activity against bacterial isolates from cases of non-gonococcal urethritis

Whole root preparations of three Nigerian medicinal plants, Anthocleista djalonensis, Nauclea latifolia and Uvaria afzalii, used traditionally in combination treatment of sexually transmitted diseases (STD), were extracted by maceration in ethanol, cold and hot water, respectively. The extracts were tested, by agar diffusion and macrobroth dilution methods, for activity against five strains of Staphylococcus aureus and two of Escherichia coli isolated from cases of STD and or urethritis. Four typed bacterial strains, S aureus ATCC 12600, Bacillus subtilis ATCC 6051, Pseudomonas aeruginosa ATCC 10145 and Escherichia coli ATCC 117755 were included as reference organisms. Ethanolic and cold-water extracts of Anthocliesta djalonensis exhibited activity against 9 and 7, respectively, of the 11 test organisms. They were bacteriostatic at minimum inhibitory concentrations (MIC) to the Gram positive strains but bactericidal to the Gram negative strains. Similar crude extracts of Uvaria afzalii showed bactericidal activity restricted to Gram positive ( Staphylococcus aureus and Bacillus subtilis) strains. Nauclea latifolia extracts were bacteriostatic to both Gram positive and Gram negative strains. No test strain was susceptible to the hot water extracts of Nauclea latifolia but five and seven strains, were respectively susceptible to similar extracts of Anthocliesta djalonensis and Uvaria afzalii. Of the seven column chromatographic fractions of the ethanolic extract of Uvaria afzalii, F ua-1 exhibited a bactericidal activity restricted to the Gram negative Escherichia coli strains, which were not susceptible to the crude extract. Fractions, F ua-2, F ua-3 and F ua-4, like the crude extract, were bactericidal against the Gram positive strains only. Thus, partial purification seems to broaden the spectrum of activity and generally improve the potency of Uvaria afzalii. These results apparently justify the use of the three plants in treatment of STD.

Asymptomatic non-chlamydial, non-gonococcal urethritis — an iatrogenic disease?

Around the middle of the twentieth century, specialist services began routinely screening asymptomatic men with a urethral smear for gram staining. The practice persists in over 90% of United Kingdom services in line with national guidelines.1 If the smear reveals ≥5 polymorphs in five or more oil-immersion fields then a diagnosis of non-gonococcal urethritis (NGU) is made, despite the absence of symptoms or a specific pathogen. Some will even fish out threads or debris from an asymptomatic man’s first-void urine and stain these, in this case looking for ≥10 polymorphs/oil-immersion field. An alternative is a leucocyte esterase test on the urine. Thus (arbitrarily) a new disease was created; necessitating counselling, antibiotic treatment, contact tracing, and frequent psychosocial dilemmas. The Americans generally go easy on the tracing of contacts of cases of asymptomatic NGU in the absence of a specific organism (C. trachomatis) being documented.2 While agreeing on the microscopic criteria for asymptomatic urethritis, in contrast to the UK neither the American nor the Australian guidelines advocate urethral smears for microscopy for asymptomatic men, though neither guidelines actually advise against the practice.3,4 Perhaps technology has advanced to the point where this time-consuming and often problematic diagnosis of asymptomatic non-chlamydial, non-gonococcal urethritis (NCNGU) (and its active pursuit in the clinic) needs to be reappraised. First, we need to ask why did the practice start in the first place? After glancing over their shoulders, a few senior UK genitourinary physicians have intimated their sceptical view that the process was devised ‘to keep the statistics up in the clinics’. By the 1950s, the introduction of penicillin had made large inroads into the major concerns of the time — gonorrhoea and syphilis. The tactic worked. NGU filled the gap and the comprehensive network of UK clinics was preserved. In the meantime, in the USA, the practice did not become as widespread and much of their clinical network was de-funded. But these days the UK clinics are straining under a massive and growing clinical burden— yet more reason to question a traditional practice with a fading rationale. Second, therewas a strong hunch (confirmed by the 1970s) that NGU often indicated an important infection (namely C. trachomatis) with serious consequences for sexual partners, and chlamydial urethritis is commonly asymptomatic. At the time (in the absence of any other test for C. trachomatis infection) this provided a compelling argument for screening for asymptomatic NGU. However, these days, a specific test for C. trachomatis is part of the routine work-up in specialist services,1 so all the urethral smear now contributes is the diagnosis of asymptomatic NCNGU. Additionally, as control programmes take effect, C. trachomatis tends to contribute shrinking proportions (typically< 20%) of acute NGU cases and even smaller proportions of asymptomatic NGU cases.2 The only consistently documented causes of NCNGU are Mycoplasma genitalium5 and Trichomonas vaginalis6 [the latter largely confined to areas of high prevalence (Table 1)] but we don’t routinely test for these organisms. The reasons that we don’t screen for these infections are because the pathogenicity ofM. genitalium has been unclear until recently5 while T. vaginalis tends to be uncommon in those services that can afford to test for it. There may be a scattering of other specific causes of NCNGU (Table 2)7−11 but there is no debate that we don’t know the cause of most cases. Thus we find ourselves in the odd predicament of having constructed and been required to manage an asymptomatic condition with generally no known cause and no known consequences. Some may chose to continue the practice of urethral smears with the justification that a sinister (as yet undiscovered) pathogen is lurking in the urethrae of thesemen and that they wouldn’t otherwise get treated. But the treatments most commonly used for NGU or NCNGU in the public sectors in the UK and the USA (tetracyclines) have no effect on T. vaginalis and, on preliminary experience, a

Symptomatic and asymptomatic chlamydial non-gonococcal urethritis in Jamaica: the potential for HIV transmission.

To determine the contribution of Chlamydia trachomatis to non-gonococcal urethritis (NGU) in men attending sexually transmitted disease (STD) clinics in Jamaica we studied men with NGU (n=339), and control groups including asymptomatic men who were STD contacts (n=61), asymptomatic men who were not STD contacts (n=32) and men with gonococcal urethritis (GU) (n=61). Urethral specimens were examined for C. trachomatis and Neisseria gonorrhoeae. Serological tests for syphilis (STS) and HIV-1 infection were also performed. C. trachomatis accounted for 63% of cases of NGU but high prevalences were also found in asymptomatic STD contacts (59%), asymptomatic STD non-contacts (78%) and men with GU (48%). The prevalence of C. trachomatis in men with GU differed significantly from that in men with NGU and asymptomatic STD non-contacts (P<0.05). C. trachomatis infection in men with NGU was associated with multiple sex partners (71% vs 58%; chi2=4.78; odds ratio (OR)=1.76; P<0.05) and previous history of gonococcal infection (83% vs 42%; chi2=59.8; OR=6.8; P<0.0001). Concomitant infection with HIV-1 occurred in 5.2% of cases of NGU and 50% and 90%, respectively, of the HIV-positive men had chlamydia or reactive STS. As a cost effective strategy in the control of STD and HIV we recommend presumptive treatment for C. trachomatis in men seeking STD treatment in Jamaica.

Urethral stricture and urethritis in men in Scotland.

To examine the incidence of urethral stricture in men in Scotland during the years 1982-1991 in relation to the changing incidence of gonococcal and non-gonococcal urethritis (NGU) over the past 20 years. Retrospective study of incidence of urethral stricture in Scotland. The number of new men in whom a diagnosis of urethral stricture was made for the years 1982-1991 was obtained using the new Scottish Record Linkage system, and the number of cases of gonorrhoea and NGU was obtained from Communicable Diseases (Scotland) Unit. Age-specific rates of urethral stricture were calculated and the Poisson regression model was used to test if there was a trend of rate with age or time change. There was a highly significant increase in the incidence of urethral stricture with age but only a slight increase in incidence over the study period within each age group. As the interaction between age and time was not significant, it is concluded that urethritis associated with sexually transmitted organisms is an uncommon cause of urethral stricture in Scotland.

Aetiology of Non-Gonococcal Urethritis: A Possible Relation to other Infections

Chlamydia trachomatis can be identified in up to 60% of cases of nongonococcal urethritis (NGU) and the aetiology of most of the remainder is obscure. This paper reports a role for other genitourinary (GU) infections such as candidiasis, warts and herpes simplex, in the causation of NGU. One hundred and ten men fulfilled the entry criteria which included the probability that their contacts would attend the department. Fifty-four of the 110 men had GU infections other than NGU; 56 had no other infections. NGU was detected in 31 (57%) of cases with other GU infections and 8 (26%) were chlamydiae-positive: in contrast NGU was found in only 10 (18%) of those with none of the other infections and 3 (30%) were chlamydiae-positive. Chlamydiae-negative NGU was, therefore, more common in those with other GU infections. Forty-five (86%) of 52 contacts of 41 patients with NGU had various GU infections such as candidosis and anaerobic vaginosis, in contrast with other GU infections in only 7 (23%) of 30 contacts of men with no other GU infections. Other GU infections in patients and their contacts appeared significantly related to the presence of chlamydiae-negative NGU.

Infection with Chlamydia trachomatis and Neisseria gonorrhoeae in Women with Lower Abdominal Pain Admitted to a Gynaecology Unit

Summary. One hundred and sixty-five women admitted to a gynaecology unit with lower abdominal pain were screened for infection with Neisseria gonorrhoeae and Chlamydia trachomatis by members of a department of genitourinary medicine. C. trachomatis alone was detected in 21 patients. N. gonorrhoeae alone was isolated from five patients, and dual infection was present in six patients, giving a total of 32 (19%) patients in whom a sexually transmitted disease (STD) was diagnosed. The combination of an endocervical swab placed in Amies transport medium for gonococcal isolation and an endocervical slide for immunofluorescent detection of chlamydiae proved to be a simple and accurate method of screening for STD. Asaresultof contact tracing, 16 sexual partners of women in whom STD was detected were examined. Three cases of gonocoecal and ninc cases of non-gonococcal urethritis were diagnosed. None of the sexual partners had Symptoms suggestive of genitourinary infection.

Infection with Chlamydia trachomatis and Neisseria gonorrhoeae in women with lower abdominal pain admitted to a gynaecology unit

One hundred and sixty-five women admitted to a gynaecology unit with lower abdominal pain were screened for infection with Neisseria gonorrhoeae and Chlamydia trachomatis by members of a department of genitourinary medicine. C. trachomatis alone was detected in 21 patients. N. gonorrhoeae alone was isolated from five patients, and dual infection was present in six patients, giving a total of 32 (19%) patients in whom a sexually transmitted disease (STD) was diagnosed. The combination of an endocervical swab placed in Amies transport medium for gonococcal isolation and an endocervical slide for immunofluorescent detection of chlamydiae proved to be a simple and accurate method of screening for STD. As a result of contact tracing, 16 sexual partners of women in whom STD was detected were examined. Three cases of gonococcal and nine cases of non-gonococcal urethritis were diagnosed. None of the sexual partners had symptoms suggestive of genitourinary infection.

PREVALENCE OF MYCOPLASMA GENITALIUM DETERMINED BY DNA PROBE IN MEN WITH URETHRITIS

The prevalence of urethral infection with Mycoplasma genitalium was determined by use of a DNA probe in 203 men attending a sexually transmitted disease clinic. M genitalium was detected in 3 (14%) of 21 with acute gonococcal urethritis; 3 (10%) of 30 with acute chlamydia-positive non-gonococcal urethritis (NGU); 4 (13%) of 31 with acute chlamydia-negative NGU; 10 (27%) of 37 with persistent or recurrent NGU; and 10 (12%) of 84 with no urethritis. The organism was more prevalent in homosexual (11 [30%] of 37) than in heterosexual men (19 [11%] of 166; p=0·009). These data do not support an important aetiological role for M genitalium in acute urethritis, but suggest that it may account for some cases of NGU that become persistent or recurrent. The higher prevalence of urethral infection in homosexual men suggests that M genitalium may reside in the gastrointestinal tract.

Sexually transmitted diseases of mucous membranes

The group of diseases termed venereal, until recently, included syphilis, gonorrhea, chancroid, lymphogranuloma venereum, and granuloma inguinale. With sexually transmitted disease now reaching epidemic proportions, as a result of a newly liberated society, the term “sexually transmitted disease” (STD), is used to refer to many other diseases that are acquired by mucous membrane or skin contact.[Contributing to the alarming rise of sexually transmitted disease is a change in moral and social attitudes that probably began with the widespread availability of birth control pills and other contraceptive methods. With a subsequent increase in number and frequency of sexual contacts, without fear of pregnancy, a number of new sexually transmitted diseases, beyond the classic venereal diseases listed previously, were reported with increasing frequency. These include the more common herpes simplex, nongonococcal urethritis, and condyloma acuminatum, as well as such serious conditions as acquired immunodeficiency syndrome (AIDS).There are 2 million new cases of gonorrhea every year; an estimated 1sol12 million new cases of nongonococcal urethritis, and sol12 million cases of herpes genitalis. This breaks down to one new case of sexually transmitted disease every 7 seconds.The following material will examine this dramatically escalating public health problem, outlining some of the more common diseases and describing the important features of each.

Problems associated with serotyping strains of Ureaplasma urealyticum

We sought to identify problems associated with serotyping Ureaplasma urealyticum, a human genital tract mycoplasma. We examined the results of serotyping isolates from cases of nongonococcal urethritis and asymptomatic controls and found no indication of correlation between serotype(s) and pathogenic potential. Reproducibility in serotype determination was generally good, i.e., overall agreement of 83% between primary and secondary plating and 87% on multiple, secondary cultures. We examined the reasons for variation in reproducibility and also the selection of a minor antigenic component in a culture. We provide no evidence of changes in the antigenicity of an isolate. We have indicated the means for standardizing reagents and the interpretation of results and have suggested improvements in methodology to allow more objective serotype determination.

Nongonococcal Urethritis: Treatment of Men and Their Sexual Partners

Determination of the optimal treatment for men with nongonococcal urethritis (NGU) has been a difficult problem. Until recently, investigators were unable to demonstrate specific etiologic agents of NGU and therefore to assess microbiologic cure. Clinical assessment of responses to therapy has been complicated by both a lack of objective criteria for definition of the disease and a tendency of the disease to resolve spontaneously over time. Nonetheless, certain antibiotics, particularly the tetracyclines and erythromycin, were found to be useful in the treatment of NGU, and the superiority of antibiotic therapy to placebo therapy was established in controlled trials [1-3]. The discovery of specific etiologic agents of NGU has greatly facilitated the study of therapy for NGU. Between 30% and 50% of NGU cases are thought to be caused by Chlamydia tracho

Chlamydial screening of pregnant women in a sexually transmitted diseases clinic.

Fifty-three consecutive pregnant women seen over six months were screened for chlamydial infection, syphilis, gonorrhoea, trichomoniasis, and candidosis. Chlamydia trachomatis was isolated in 20 (37.7%) patients, of whom six were sexual partners of known cases of non-gonococcal urethritis (NGU) (two had associated gonorrhoea or candidosis) and six had gonorrhoea (three had associated trichomoniasis and candidosis). If treatment is given to contacts of NGU 14 patients with other presenting conditions would not have been treated unless chlamydial cultures had been performed. This may lead to potentially serious complications of chlamydial infection in both mothers and neonates.

Chlamydial Infections

Chlamydia trachomatis was first described by Halberstadter and Von Prowazek in 1907, as a characteristic intracytoplasmic inclusion in the conjunctival scrapings from a patient with trachoma. Although the organism was identified as the etiologic agent of trachoma and inclusion conjunctivitis in the neonate, a full understanding of its nature was not feasible until C trachomatis was first successfully propagated in cell cultune in 1965. This technical innovation greatly facilitated investigation of the biology and the epidemiology of chlamydial infections in man. C trachomatis is now recognized to be one of the most prevalent sexually transmitted diseases in the United States today. It is responsible for 40% to 50% of cases of nongonococcal urethritis (NGU) in men and a large reservoir of genital infection, largely asymptomatic, in women. In the United Kingdom, where NGU is a reportable disease, NGU is now more prevalent than gonorrhea and is considered to be the most important male veneral disease. The cervical infection in women is of special importance to pediatricians as the infection may be transmitted to the infant during parturition, leading to both ocular and respiratory disease. A thorough understanding of the microbiology and epidemiology of C trachomatis is an important prerequisite for appreciating the clinical features, diagnostic methods, and management of these infections by pediatricians.

Antimicrobial drug susceptibility of 15 strains of Chlamydia trachomatis recently isolated from cases of non-gonococcal urethritis, in Italy.

Journal Article Antimicrobial drug susceptibility of 15 strains of Chlamydia trachomatis recently isolated from cases of non-gonococcal urethritis, in Italy Get access R. CEVENINI, R. CEVENINI Institute of Microbiology of the UniversityPoliclinico S. Orsola I-40138 Bologna, Italy Search for other works by this author on: Oxford Academic PubMed Google Scholar M. P. LANDINI, M. P. LANDINI Institute of Microbiology of the UniversityPoliclinico S. Orsola I-40138 Bologna, Italy Search for other works by this author on: Oxford Academic PubMed Google Scholar M. DONATI, M. DONATI Institute of Microbiology of the UniversityPoliclinico S. Orsola I-40138 Bologna, Italy Search for other works by this author on: Oxford Academic PubMed Google Scholar F. RUMPIANESI F. RUMPIANESI Institute of Microbiology of the UniversityPoliclinico S. Orsola I-40138 Bologna, Italy Search for other works by this author on: Oxford Academic PubMed Google Scholar Journal of Antimicrobial Chemotherapy, Volume 6, Issue 2, March 1980, Pages 294–296, https://doi.org/10.1093/jac/6.2.294 Published: 01 March 1980

Epidemiological importance of concealed nongonococcal urethritis.

Of the 229 806 new male patients attending venereal disease clinics in England in 1976, 31.9% had recognisable non-specific genital infection (NSGI), which was easily the most common diagnostic category of the sexually transmitted diseases (STDs) and one which had increased more markedly than all the others in the previous 25 years. Many more cases of nongonococcal urethritis (NGU) are concealed under the diagnosis of gonorrhoea, as is clear from the high incidence of post-gonococcal infection following treatment with penicillin. From 44% to 56% of male patients with gonorrhoea can also have non-specific genital infection during the same year. A practical treatment schedule for gonorrhoea which is also effective against simultaneously acquired non-gonococcal urethritis would be of great value.

Ureaplasma urealyticum and Mycoplasma hominis in chlamydial and non-chlamydial nongonococcal urethritis.

Urethral specimens from 726 patients with nongonococcal urethritis (NGU) were examined for Chlamydia trachomatis, Ureaplasma urealyticum, and Mycoplasma hominis. Chlamydiae were isolated from 35.9% of ureaplasma-positive patients and from 36.5% of ureaplasma-negative patients. Ureaplasmas were isolated from 52.5% of chlamydia-positive patients and from 53.1% of chlamydia-negative patients, an observation which contrasts with that of some workers who have suggested that ureaplasmas are significantly associated with chlamydia-negative NGU. Furthermore, the numbers of ureaplasmas isolated from patients who did or did not harbour chlamydiae were not significantly different nor was there a particular association of ureaplasmas with chlamydia-negative NGU in patients experiencing their first episode of disease. In addition, M. hominis was not isolated more frequently from those from whom chlamydiae were or were not isolated. The only significant associations were the isolation of M. hominis from patients who were ureaplasma-positive and of ureaplasmas from those who were M. hominis-positive. These findings do not necessarily mitigate against ureaplasmas being responsible for some cases of chlamydia-negative NGU.

Etiology of nongonococcal urethritis. Evidence for Chlamydia trachomatis and Ureaplasma urealyticum.

Chlamydia trachomatis, Ureaplasma urealyticum (T-mycoplasma), and Hemophilus vaginalis have previously been considered possible etiological agents in nongonococcal urethritis (NGU). In this study, current C. trachomatis infection was confirmed by culture and (or) micro-immunofluorescence serology in 26 of 69 men experiencing afirst episode of NGU, and 1 of 39 with no urethritis. Serum IgM immunofluorescent antibody to chlamydia was demonstrated in 16 of 20 men with chlamydia culture positive NGU, and 3 of 39 with chlamydia culture negative NG, and none of 34 with no urethritis. 9 of 10 culture positive men with less than or equal to 10 days symptoms developed immunofluorescent antibody seroconversion in paired sera. U. realyticum was isolated significantly more often and in significantly higher concentration from first voided urine from chlamydia-negative cases of NGU than from chlamydia-positive NGU. Ureaplasmacidal antibody titers increased fourfold in six men, four of whom had negative cultures for for unreaplasma. H. vaginalis was isolated from c9 of 33 men with no urethritis and 2 of 69 with NGU. C. trachomatis is susceptible, and U. urealyticum is resistant to sulfonamides. A 10-day course of sulfisoxazole therapy produced improvement in 13 of 13 chlamydia-positive, unreaplasma-negative, and only 14 of 29 chlamydia-negative, unreaplasma-positive NGU cases (P less than 0.002). Thus, culture, serology, and response to therapy support the etiologic role of chlamydia in NGU. Quantitative culture and response to therapy suggest U. unrealyticum may cause many cases of chlamydia-netative NGU.