Non-gonococcal urethritis (NGU), a common sexually transmitted infection, is caused by various pathogens excluding Neisseria gonorrhoeae. It encompasses a group of diseases characterized by urethritis symptoms but without the presence of gonococcal bacteria in secretions or cultures. In developed Western countries, NGU has surpassed gonorrhea as the most prevalent sexually transmitted disease, and its incidence is also rising in American. The primary pathogens include Chlamydia trachomatis and Mycoplasma. NGU accounts for approximately 50% of sexually transmitted infections, particularly among heterosexual men, while being less common in homosexual men. Complications in men may include epididymitis, prostatitis, and seminal vesiculitis, while women may experience pelvic inflammatory disease. NGU is also linked to male infertility, female infertility, ectopic pregnancy, and adverse pregnancy outcomes. It often coexists with gonococcal urethritis and predominantly affects young adults, with over 60% of cases occurring in individuals aged 25 and above.
Cervicitis: A Common Manifestation in Women
In women, NGU often presents as cervicitis, also known as mucopurulent cervicitis (MPC). Causative agents include Chlamydia trachomatis, herpes simplex virus (types I and II, primarily type II), cytomegalovirus, human papillomavirus, and group B streptococcus. Approximately 75% of chlamydial infections are asymptomatic, though some women may experience increased vaginal discharge. Clinical examination may reveal mucopurulent discharge from the cervical os, cervical erythema, edema, and erosion, sometimes presenting with a characteristic hypertrophic follicular appearance. Untreated chlamydial cervicitis can persist for over a year, leading to complications such as urethritis, endometritis, adult ocular infections, neonatal infections, and even tubal scarring, pelvic pain, and increased risks of ectopic pregnancy and infertility.
Urethritis: Subtle but Significant
Urethritis in NGU is often asymptomatic, though some patients may report mild symptoms such as dysuria, urethral burning, urinary frequency, or difficulty urinating. The urethral meatus may appear normal or slightly erythematous, with minimal discharge upon compression.
Pelvic Inflammatory Disease: A Serious Complication
Pelvic inflammatory disease (PID) is a severe complication of NGU, primarily caused by Chlamydia trachomatis, Mycoplasma hominis, and mixed aerobic and anaerobic infections. Approximately 9.5% to 27% of chlamydial infections can lead to PID, manifesting as endometritis, salpingitis, and inflammation of surrounding structures. Symptoms include lower abdominal discomfort, bladder irritation, and in severe cases, fever, headache, chills, and abdominal tenderness or rebound pain.
Neonatal Infections: A Maternal Concern
About 50% of newborns exposed to an infected mother during delivery may develop chlamydial conjunctivitis or pneumonia, highlighting the importance of maternal screening and treatment.
Infertility: A Long-Term Consequence
Female infertility may result from inflammatory adhesions or blockages in the reproductive tract caused by chlamydial endotoxins, impairing ovulation and egg transport. Additionally, Ureaplasma urealyticum produces neuraminidase-like substances that can interfere with sperm-egg binding, further contributing to infertility.
Other Adverse Outcomes
NGU is also associated with ectopic pregnancy, recurrent miscarriage, and low birth weight infants, underscoring its significant impact on reproductive health.
Conclusion
Non-gonococcal urethritis is a multifaceted condition with far-reaching implications for sexual and reproductive health. Its rising prevalence and potential complications necessitate increased awareness, timely diagnosis, and effective treatment to mitigate its impact on individuals and public health.
