Nongonococcal urethritis (NGU) is primarily caused by pathogens such as Chlamydia trachomatis or Ureaplasma urealyticum. Other potential causative agents include Trichomonas vaginalis, herpes simplex virus, hepatitis viruses, Candida albicans, and Mycobacterium smegmatis. It is typically transmitted through sexual contact, either heterosexual or homosexual. Nongonococcal urethritis has a higher incidence rate compared to gonococcal urethritis and ranks as the most common sexually transmitted infection.
The onset of symptoms generally occurs 1–5 weeks after infection. Clinical manifestations include itching or irritation of the urethra, dysuria, and the discharge of a small amount of thin, whitish fluid. In some cases, symptoms may present only as crusting around the urethral meatus or soiling in the underwear, often observed in the morning. In male patients, the infection may involve the epididymis, leading to acute epididymitis and potentially resulting in male infertility.
Diagnosis
Diagnosis is based on characteristic clinical symptoms and a history of sexual contact involving unprotected or unsafe practices. Urethral discharge collected in the early morning before urination is suitable for Chlamydia or Ureaplasma culture. Nongonococcal urethritis can coexist with gonococcal urethritis in the same patient simultaneously, requiring careful differentiation given the similarity in symptoms. Microscopic examination of urethral smears showing 10–15 polymorphonuclear leukocytes per high-power field, in combination with evidence of Chlamydia or Ureaplasma inclusion bodies and the absence of intracellular gram-negative diplococci, aids in distinguishing nongonococcal urethritis from gonococcal urethritis.
Treatment
Effective treatment includes the use of antibiotics such as minocycline or erythromycin. Concurrent treatment of the sexual partner is recommended to reduce the risk of reinfection.