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Nongonococcal Urethritis
and Chlamydial Cervicitis
Nongonococcal urethritis and chlamydial
cervicitis are sexually transmitted diseases caused by the
bacterium Chlamydia trachomatis and various other microorganisms
that produce inflammation of the urethra and cervix.
Several different microorganisms cause diseases that resemble
gonorrhea. These microorganisms include Chlamydia trachomatis,
Trichomonas vaginalis, and several different types of
Mycoplasma. In the past, these microorganisms were
hard for laboratories to identify, so the infections they
caused were simply called "nongonococcal" to indicate
that they were not caused by Neisseria gonorrhoeae,
the bacterium that causes gonorrhea.
Chlamydia trachomatis infection (chlamydia) is very
common, with 659,000 reported cases in the United States in
1999. Because the infection sometimes produces no symptoms,
even more people may be affected. In men, chlamydia causes
about half of the urethral infections not caused by gonorrhea.
Most of the remaining male urethral infections are caused
by Ureaplasma urealyticum. In women, chlamydia accounts
for virtually all of the pus-forming cervical infections not
caused by gonorrhea. Both sexes may acquire gonorrhea and
chlamydia at the same time.
Symptoms and Diagnosis
Between 4 and 28 days after intercourse with an infected person,
an infected man typically has a mild burning sensation in
his urethra while urinating. A clear or cloudy discharge from
the penis may be evident. The discharge is usually less thick
than the discharge that occurs in gonorrhea. Early in the
morning, the opening of the penis is often red and stuck together
with dried secretions. Occasionally, the disease begins more
dramatically. The man needs to urinate frequently, finds urinating
painful, and has discharge of pus from the urethra.
Although most women infected with Chlamydia have
few or no symptoms, some experience frequent urges to urinate
and pain while urinating, pain in the lower abdomen, pain
during sexual intercourse, and secretions of yellow mucus
and pus from the vagina.
Anal infections may cause pain and a yellow discharge of
pus and mucus.
In most cases, a doctor can diagnose chlamydia by examining
discharge from the penis or cervix in a laboratory. Newer
tests that amplify DNA or RNA, such as the polymerase chain
reaction (PCR), enable a doctor to diagnose chlamydia or gonorrhea
from a urine sample. These tests are recommended for screening
of sexually active women between the ages of 15 and 25. Genital
infections with Ureaplasma and Mycoplasma
are not diagnosed specifically in routine medical settings,
because culturing of these microorganisms is difficult and
other techniques for diagnosis are expensive. The diagnosis
of nongonococcal infections is often presumed if the person
has characteristic symptoms and no evidence of gonorrhea.
If chlamydia is not treated, symptoms usually disappear in
4 weeks. However, an untreated infection can cause a number
of complications. Untreated chlamydial cervicitis often ascends
to the fallopian tubes (tubes that connect the ovaries to
the uterus), where inflammation may cause pain and scarring.
The scarring can cause infertility and ectopic pregnancy.
These complications can occur in women without symptoms and
result in considerable suffering and medical costs. In men,
chlamydia may cause epididymitis, which produces painful swelling
of the scrotum on one or both sides. Whether Ureaplasma
has a role in these complications is unclear.
Treatment
Chlamydial and ureaplasmal infections are usually treated
with tetracycline, doxycycline, or levofloxacin taken by mouth
for at least 7 days or with a single dose of azithromycin
taken by mouth. Because the symptoms are so similar to those
of gonorrhea, doctors usually give an antibiotic such as ceftriaxone
to treat gonorrhea at the same time. Pregnant women are given
erythromycin instead of tetracycline or doxycycline. If symptoms
persist or return, treatment is then repeated for a longer
period.
Infected people who have sexual intercourse before completing
treatment may infect their partners. Also, partners who are
infected may re-infect the treated person. Thus, sex partners
are treated simultaneously if possible. The risk of a repeat
infection of chlamydia or another STD within 3 to 4 months
is high enough that screening may be repeated at that time.
To read the rest
of this excellent article on sexually transmitted diseases,
along with detailed information on each of the diseases, please
click here: http://www.merck.com/mmhe/sec17/ch200/ch200d.html
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Additional
Information