Nongonococcal urethritis - A new paradigm

Urethritis in men has been categorized historically as gonococcal or nongon ococcal (NGU). The major pathogens causing NGU are Chlamydia trachomatis an d Ureaplasma urealyticum. Trichomonas vaginalis may be involved occasionall y. In up to one-half of cases, an etiologic organism may not be identified. In this review we present recent advances in the diagnosis and management of NGU and discuss how they may be applied in a variety of clinical setting s, including specialized STD clinics and primary health care practices. In particular, the development of the noninvasive urine-based nucleic acid amp lification tests may warrant rethinking of the traditional classification o f urethritis as gonococcal urethritis or NGU. Diagnostics for Chlamydia are strongly recommended because etiologic diagnosis of chlamydial urethritis may have important public health implications, such as the need for partner referral and reporting. A single 1-g dose of azithromycin was found to be therapeutically equivalent to the tetracyclines and may offer the advantage of better compliance.