Organism A number of organisms have been found to be responsible for urethritis not caused by the gonococcus, including Chlamydia trachomatis, Ureaplasma urea-lyticum, Trichomonas vaginalis and Mycoplasma hominis.
Clinical features A low-grade urethritis with mucoid rather than purulent discharge in the male, in which intracellular diplococci are not found in the smear, suggests NGU. Infection is a low-grade discharge in the female or is often asymptomatic so that a reservoir of infection can occur if simultaneous treatment to both sexual partners is not given. Sterility in women can result if the infection is not treated. In areas where gono-coccal urethritis is common, the prevalence of NGU is also high so treatment should be given for both conditions.
Diagnosis This differs markedly in different parts of the world with developing countries adopting a syndromic approach (see above under gonorrhoea), while developed countries specifically test for Chlamydia. Where possible, diagnosis should be made by smear and culture, the absence of intracellular diplococci indicating NGU. The nucleic acid amplification test (NAAT) or IF test with monoclonal antibody can be used on urethral or cervical swabs.
Transmission is by sexual intercourse. C. trachomatis and T. vaginalis are risk factors for HIV infection in the female.
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