Non-gonococcal u-rethritis (NGU) refers to a type of urethritis transmitted by sexual contact. It has clinical manifestations of urethritis, but no gonococcus can be found in urethral secretions. Because women have not only inflammation of the urethra, but also inflammation of the reproductive tract such as cervicitis.
Introduction to non-gonococcal urethritis
Non-gonococcal u-rethritis (NGU) [1] refers to a type of urethritis transmitted by sexual contact. It has clinical manifestations of urethritis, but it is not found in urethral secretions. Neisseria gonorrhoeae. Because women have not only inflammation of the urethra, but also inflammation of the reproductive tract such as cervicitis. Therefore, it is not enough to just call it urethritis, and it is called non specific genital infection (NSGI). Patients can be infected with both gonococcus and chlamydia trachomatis in a single exposure. Due to the short incubation period of gonococcal urethritis, onset occurs after an average of 3-5 days, while the incubation period of chlamydia infection is longer, usually 1-3 weeks. Therefore, after the gonorrhea is cured, the incubation period of NGU is reached and the onset of the disease begins. This kind of urethritis that occurs after gonorrhea is called "post-gonorrhea urethritis" (PGU), which is actually a manifestation of NGU.
The pathogens of this disease are mainly Chlamydia trachomatis and Mycoplasma. Therefore, the disease tends to be renamed as "Chlamydia trachomatis urogenital infection" and "Mycoplasma urogenital infection" respectively. This disease has the highest incidence of STD in Western countries. Non-gonococcal urethritis refers to a type of urethritis transmitted by sexual contact. It has clinical manifestations of urethritis, but no gonococcus can be found in urethral secretions. 30% -40% of male non-gonococcal urethritis patients have no symptoms, and many patients have atypical symptoms, and about half of the patients are easily misdiagnosed at the initial diagnosis. Typical symptoms are urinary tract spasm with varying degrees of frequent urination, urgency, dysuria, and difficulty urinating. If you do not urinate for a long period of time or before urination for the first time in the morning, a small amount of fluid secretion may escape from the outer urethra, and severe cases may have purulent fluid. Non-gonococcal urethritis symptoms persist or recur in 10% of cases. These patients are often associated with incomplete or inappropriate treatment, abnormal urethral structure, excessive drinking, frequent sexual activity, and psychological disorders. Women with non-gonococcal urethritis are mostly asymptomatic. When there is urethritis, about 50% of patients have urgency, frequent urination, and difficulty urinating, but no symptoms of dysuria or only mild urination. The cervix is the main infection site for women. The main symptom is salary purulent endometritis, which may have symptoms such as increased vaginal discharge, vulvar vaginal itching, and lower abdominal discomfort. Neisseria gonorrhoeae and non-gonococcal urethritis have similar symptoms, and some severe bacterial urethritis also have similar symptoms, which can easily lead to misdiagnosis and missed diagnosis, especially in cases of co-infection. Therefore, the symptoms of non-gonococcal urethritis should be checked and treated at the hospital as soon as possible.
Epidemiological perspective of non-gonococcal urethritis
Since the mid 1960s, the number of patients with chlamydia infection has been increasing. According to the World Health Organization, 250 million new cases of venereal disease can be cured each year, of which 67 million are chlamydia infections. According to the office data, the rates of chlamydia infection in low-risk groups of STDs were 5.6% (Philippines) and 2.5% (Vietnam) from 1993 to 1996, while in high-risk groups (prostitutes, dark prostitutes), the infection rate reached 17.3% (Philippines) . In England and Wales, the number of NGU cases reported from 1960 to 1986 has increased from 22,000 to 110,000. In the United States, the incidence of chlamydia infection has increased from 91.4 / 100,000 in 1987 to 197.5 / 100,000 in 1991. In China, the incidence of NGU is also increasing year by year. According to the data of 26 surveillance sites for individual diseases, the number of NGU cases reported in 1993 was 1 404, with an incidence rate of 4 / 100,000, accounting for the third place in STDs; 1998 The number of reported cases of NGU is 121 564, with an incidence rate of 9.74 / 100,000, which has doubled in five years, but still ranks third among STDs; the number of reported cases of NGU in 2000 was 241,016, and the incidence rate At 19.33 / 100,000, the incidence of NGU nearly doubled in two years, and the venereal disease location surpassed the genital warts and ranked second. There are more women than men. According to statistics from 35 states in the United States from 1987 ^ -1991, the ratio of women to men in cases of chlamydia infection was 5.9: 3.3. In 1991, the incidence of women was 281.2 / 10 million, compared with 47.7 / 10 for men. Million. The cause may be that asymptomatic women are effectively screened and male sexual partners who infect women are not diagnosed, treated, and reported. In our country, it appears that there are more men than women in terms of reported cases. In addition, chlamydia infection is also related to multiple sexual partners and previous gonococcal infection history. It should be noted that due to the limitation of inspection methods and epidemic reporting systems, the incidence of NGU cannot be very accurate. If simple diagnostic methods can be provided, it is estimated that the number of people affected will increase and be closer to the actual number of people.
Non-gonococcal urethritis etiology
40% -50% of the disease is caused by Chlamydiatrachomatis, 20% -30% is caused by ureaplasma urealyticum, and 10% -20% are caused by trichomonas vaginalis, Candida albicans (candida albicans), herpes simplex virus, my-coplasma genitalium, adenovirus, and bacilli.
Non-gonococcal urethritis chlamydia
Chlamydia is a microorganism between bacteria and viruses. It is parasitic in human cells and contains DNA and RNA. In its life cycle, there are two forms of primitive and primitive. The primitive body is small (200 ~ 300nm in diameter), dense in cytoplasm and highly contagious. After entering sensitive cells, it becomes larger (up to 800 ^ 1 200nm in diameter) and becomes a precursor. The cytoplasm becomes loose or reticulate. Therefore, the precursor is also called reticulate. It is not contagious but has metabolic activity In the host cell, two-division reproduction is performed. Chlamydia has 15 serotypes, of which types A, B, Ba and C cause trachoma, and types D, E, F, G, H, I, J and K cause urethritis, epidemic inflammation, prostatitis, proctitis, cervix Inflammation, salpingitis, pelvic inflammatory disease, perihepatitis, and Re-iter disease, L1, L2, and L3 types cause STD lymphogranuloma. Chlamydia is sensitive to heat. It can survive only 5 ^-10 min at 56-60 ° C, but it can withstand low temperatures and survive for several years under freezing conditions. The Jiaoyan Jieyin lotion containing PHMB bactericidal ingredient tested by the Institute of Microbiology of the Chinese Academy of Sciences can quickly kill it, proving that Chlamydia is weakly resistant to PHMB and other germicidal agents. According to reports from many countries, 30% -50% of NGU, 20% of gonorrhea patients, and 0.5% of people with strong sexual activity but no symptoms of urethral inflammation, urinary tract secretions can culture chlamydia using current culture methods. Because female patients are mostly asymptomatic or only show gynecological symptoms such as increased vaginal discharge, it is difficult to determine their incidence. Some people estimate that female patients may be four times as many as male patients. Chlamydia is a microorganism that is attached to the cytoplasm of glandular epithelial cells. It is spherical and has a special growth cycle. There are two developmental types in each growth cycle. The infectious type is a spherical elementary body with a size between bacteria and virus (300-400mm). Primitives can survive extracellularly and are infectious. When it is attached to the surface of susceptible cells, it is swallowed by the cells, and the protozoa in the cells become another reproductive type. The reproductive type is the initial body. The initial body is round or oval. The original body reproduced in two divisions, and finally the original body was reorganized into the original body, released from the cells, and then infected with other healthy susceptible cells. The entire growth cycle is 72h. Chlamydia classification: 1. Chlamydia parrot. 2. Chlamydia trachomatis Chlamydia trachomatis has at least 15 serotypes. D-K8 serotypes are related to NGU. The L1, L2, and L33 types are related to venereal lymphogranuloma (fourth venereal disease).
Non-gonococcal urethritis
Mycoplasma belongs to flexible membrane prokaryotes, which can grow on artificial medium. Because it does not have a cell wall, it is morphologically diverse, and is usually round, oval, club-shaped, and irregular. It can pass through cell filters. Mycoplasma cultured on solid or semi-solid medium to form "fried egg-like" special morphology colonies, which has important reference value for the identification of Mycoplasma. The mycoplasma that causes NGU is mainly mycoplasma anaemia, which is a special type of mycoplasma. The colonies are small, only 10nm in the dense place of growth, it is often parasitic in the urethral epithelium, and can break down urea into ammonia. Mycoplasma has a weak resistance to the external environment. It can be killed by heating at 450C for 15-30min or 550C for 5-15min. Common disinfectants in the laboratory such as formalin, carbolic acid, and phenol soap solution can easily kill it. Inactivated. The Jiaoyan Jieyin lotion containing PHMB bactericidal ingredient tested by the Institute of Microbiology of the Chinese Academy of Sciences can quickly kill it, proving that mycoplasma, like chlamydia, has a low tolerance to PHMB and other bactericidal preparations. It is not sensitive to antibiotics that affect wall synthesis, such as penicillin, but erythromycin, tetracycline, streptomycin, and chloramphenicol, which act on mycoplasma nucleoproteins, can inhibit or affect protein synthesis and kill mycoplasma.
1. ureaplasma ure-alyticum is a prokaryotic microorganism. Can produce urea decomposing enzyme to decompose urea. Cue-shaped. Because it lacks a hard cell membrane, it is not inhibited by penicillin. Tetracycline, erythromycin, and spectinomycin are effective. Seven species of mycoplasma have been isolated from the human urogenital tract, of which the separation rate is high and is related to urogenital tract diseases. It is the decomposition of mycoplasma urea, followed by human mycoplasma. Mycoplasma urealyticum is not found in the genital tract of infants or non-sexual females. The more chaotic the sex life, the higher the positive rate of this mycoplasma. Mc Donald reported in 1982 that in 587 patients with acute urethritis symptoms, 209 (36%) of the middle-stage urine had isolated mycoplasma urealyticum.
2. Mycoplasma hominis Mycoplasma hominis has a weak resistance to the external environment and can be killed at 45 for 15min. In addition to causing urethritis and ocular conjunctivitis, chlamydia can also cause inflammation of other reproductive organs, such as epididymitis, prostatitis, cervicitis, vaginitis, salpingitis, and pelvic inflammation. Newborns can induce conjunctivitis and pneumonia through the infected birth canal. Male homosexuals can develop proctitis and pharyngitis.
Pathogenesis of non-gonococcal urethritis
1. Pathogenic mechanism of C. trachomatis After host cells are infected by C. trachomatis, sugar metabolism and protein metabolism are not significantly affected, but nucleic acid synthesis is severely inhibited. One possible reason for this inhibition is that Chlamydia trachomatis produces an inhibitory substance in the cytoplasm, which blocks DNA synthesis by host cells. Another possible reason is that the host cell nucleus competes with Chlamydia trachomatis in the cytoplasm to contain energy in the cytoplasm and precursors necessary for the synthesis of DNA, and Chlamydia trachomatis is dominant; this way Chlamydia trachomatis uses energy and host cells in the host cell. The nutrient material develops from the primitive body into the original body, and then propagates in the form of two divisions to produce the primitive body. This cycle is repeated, which generates a large number of primitive bodies and generates harmful metabolites, which often leads to the rupture of the inclusion body membrane and the death of host cells. . A large number of progeny of Chlamydia trachomatis are subsequently released, infecting new susceptible cells. During Chlamydia trachomatis infection, the host will experience humoral and cellular immune responses. These reactions have a dual effect. On the one hand, it has immune defense and protection, and on the other hand, it can also cause immune damage. Humoral immunity involves systemic and local antibodies. Protective immunity against Chlamydia trachomatis is serotype-specific, can neutralize the infectivity of Chlamydia trachomatis, and has limited protection against reinfection. However, this effect is short-term, and reinfection with Chlamydia trachomatis after a long time interval is not protective. Cellular immunity is multifaceted. On the one hand, under the stimulation of heat shock protein (HSP60) of the outer membrane of Chlamydia trachomatis, specific cytotoxic T lymphocytes will be generated, which can lyse cells infected by various serotypes of C. trachomatis. On the other hand, it will activate CD4 and CD dream T cells; CD4 T cells secrete cytokines, activate non-specific effector cells and antigen-specific effector cells such as B cells and CDS T cells; CD T cells function mainly to lyse target cells, It plays an important role in defending against viral infections and intracellular parasitic infections. On the other hand, recently discovered a T cell carrying y8T cell receptors in surrounding tissues such as the epidermis and epithelium. This cell can induce the defense response of Thl cells when stimulated by HSP60. This response may be produced by 7-interferon and medium intensity protection. The main pathological change of the host caused by Chlamydia trachomatis infection is chronic inflammation, which causes tissue damage and paralysis. The specific mechanisms of these changes have not yet been clarified, but it is known that the host-mediated immune system response plays a significant role in promoting the occurrence of chronic traumatic sequelae.
2. Pathogenic mechanism of Mycoplasma avenae Mycoplasma avenae can be attached to the surface of urogenital epithelial cells, red blood cells, macrophages and sperm via receptors. After Mycoplasma hemolytica is attached to the surface of the host cell, it immediately takes in nutrients from the surface of the host cell, and uses the cholesterol in the membrane to deplete the main components of the host cell membrane, causing damage to the host cell. After the Mycoplasma avenae is attached to the surface of the sperm, in addition to hindering sperm movement, the neuraminidase-like substance produced can also interfere with the sperm-egg binding, causing infertility and infertility. The urease in Mycoplasma lytica decomposes urea to produce a large amount of ammonia, which poisons the cells.
Non-gonococcal urethritis
Because NGU has a slow onset and mild symptoms, it is not easy to be taken seriously. Pathogens that cause non-gonococcal urethritis can persist for months and require longer treatment. Those who have complications after non-formal medication can carry bacteria for a long time. The absence of condoms during intercourse has also contributed to the growing epidemic of non-gonococcal urethritis.
1. Sexual contact transmission is caused by sexual contact between NGU patients or carriers. Adult men use the urethra and women use the cervix as the infection site. Mycoplasma infection rate of genitourinary tract increases with the number of sexual partners. More than 6 men with sexual partners, 48% have Mycoplasma hemolyticum infection; women with sexual intercourse have a high detection rate of mycoplasma high.
2. Infection of the birth canal Newborns can be infected by the mother's birth canal during childbirth, which can cause neonatal pneumonia, conjunctivitis and baby girl vaginitis.
3. Indirect infection Infected through indirect contact through the patient's clothing, utensils or obstetrics and gynecology equipment without strict disinfection.
4. Autogenous infection The pathogen can be transmitted from the genital contact to the eyes or throat through hands or pollutants.
Clinical manifestations of non-gonococcal urethritis
NGU occurs predominantly in young people, accounting for about 60% of those over the age of 25. The incubation period is longer than gonorrhea, with an average of 1-3 weeks. The symptoms of NGU differ between men and women.
Main clinical manifestations of men with non-gonococcal urethritis
(1) Symptoms: 30% -40% of patients are asymptomatic, and many patients have atypical symptoms. About half of the patients are susceptible to misdiagnosis at the initial diagnosis. Typical symptoms are urinary tract spasm with varying degrees of frequent urination, urgency, dysuria, and difficulty urinating. If you do not urinate for a long period of time or before urination for the first time in the morning, a small amount of fluid secretion may escape from the outer urethra, and severe cases may have purulent fluid. Symptoms persist or recur in 10% of cases. These patients are often associated with incomplete or inappropriate treatment, abnormal urethral structure, excessive drinking, frequent sexual activity, and psychological disorders. In recurrent cases, the condition of each attack is generally lighter than the previous one, but the patient's mood is heavier than the previous one, and some even feel restless, lest they have incurable disease. In some cases with frequent attacks, the urethral discomfort persists even during the inter-seizure period; in other cases, the symptoms are not obvious, but there are more pus cells in the urethral discharge smear.
(2) signs: common urethral swelling and urethral discharge. Intractable cases of recurrent Chlamydia infection, a circle around the urethral orifice, often lip-like swelling, with gloss, is not easy to subside; intractable cases of Candida infection, the urethral orifice may expand like a funnel, dark red with a little Squamous scales, mostly with balanitis; mycoplasma and trichomoniasis are not obvious for urethral redness and swelling. Urethral secretions are usually serous or purulent. Mycoplasma, Candida albicans, and herpes simplex virus infections are mostly serous, and Chlamydia or bacterial infections are mostly purulent. Herpes simplex virus infection can cause inguinal lymphadenopathy and tenderness.
Clinical manifestations of female patients with non-gonococcal urethritis
(1) Symptoms: Most are asymptomatic. When there is urethritis, about 50% of patients have urgency, frequent urination, and difficulty urinating, but no symptoms of dysuria or only mild urination. The cervix is the main infection site for women. The main symptom is salary purulent endometritis, which may include symptoms of increased vaginal discharge, vulvar vaginal itching, and lower abdominal discomfort.
(2) Signs: Check the urethral mouth for flushing and swelling, and compress the urethra for a small amount of pale yellow discharge. A white cotton swab was inserted into the cervix and turned slightly. After removal, the swab became pale yellow. Cervical congestion and edema often occur, and swabbing at the junction of squamous and columnar epithelium can cause bleeding. Because chlamydia and mycoplasma do not parasitize stratified squamous epithelium, they generally do not cause vaginitis.
Nongonococcal urethritis complications
Complications of non-gonococcal urethritis in men
prostatitis
Urination in the acute phase is more painful and radiates toward the urethra, scrotum, and buttocks. Swelling in the rectum. Can also be combined with dysuria and painful penile erections, a few accompanied by fever or general discomfort. Digital rectal examination showed enlarged prostate and tenderness. Transparent filaments or off-white lumps may appear in the urine. Most patients begin with chronic manifestations, with mild urination, perineum, groin, upper pubic symphysis, and mild pain or soreness at the lower back. The prostate was asymmetrically enlarged, hardened, or indurated during examination.
Epididymitis
Can be divided into acute and chronic. Acute non-gonococcal epididymitis is rare, with an incidence rate of 1%. It often coexists with urethral inflammation, and is mostly unilateral. Appeared as epididymal enlargement, hardening, thickened vas deferens, tenderness, and also scrotal edema. In the chronic phase, epididymides may have induration and spermatic cord thickening. Acute attacks can often be caused by causes such as excessive sexual life and alcoholism. Serum antibodies are significantly increased during epididymitis. Therefore, serological examination is of great significance in the diagnosis of epididymitis.
Seminal vesicle seminiferitis
Seminal vesicle seminiferitis: often coexist with the prostate. Its clinical manifestations are similar to prostatitis, with symptoms such as bloody semen, pain in ejaculation, and increased frequency of nocturnal emission. A digital rectal examination can reveal tenderness, swelling, or a bunch of ties on the upper sides of the prostate.
Reiter disease
Reiter's disease: The patient has urethritis, ocular conjunctivitis, and multiple symmetrical arthritis. Some patients have superficial erosion in the head and foreskin of the penis, and the edges are slightly higher, fused into a multi-ring, called ring penile cephalitis. The most commonly affected joints are the knees, condyles, and elbows. Joint disease can last up to several months, occasionally complicated by myocarditis, pleurisy, and polyneuritis. Extraction of joint exudate can sometimes detect chlamydia. Anti-Chlamydia antibody titers also increased in serum. But Reiter syndrome can be caused by a variety of causes, and Chlamydia infection is only one of them.
The main complications of Chlamydia trachomatis infection in women with non-gonococcal urethritis are
Acute and chronic pelvic inflammatory disease
Acute pelvic inflammatory disease manifests as fever, headache, loss of appetite, and lower abdominal pain, which can be accompanied by gastrointestinal symptoms such as bloating, nausea and vomiting. During the examination, there were tenderness and rebound tenderness in the lower abdomen, tenderness and mobility of the uterine body, and tenderness on both sides of the uterine body, sometimes with swelling. In chronic pelvic inflammatory disease, the systemic symptoms are mostly not obvious, mainly manifested in the lower abdomen, swelling and pain, backache and leucorrhea. Irregular menstruation occurs when ovarian function is affected. Endometritis can increase menstrual flow, prolong or shorten the menstrual period, and dull pain in the lower abdomen. Uterine body movement is limited, one or both sides of the fallopian tube thickened like a cord, sometimes they and cystic masses, tenderness around. Repeated attacks can lead to tubal obstruction and infertility and ectopic pregnancy, abortion, premature birth and stillbirth.
Vestibular glanditis
Flushing, edema, and local pain appear in the openings of the glands between the labia minora and the hymen, and abscesses can occur in severe cases. Chronic recurrent episodes can form cysts, and enlarged swelling ducts and glands can be touched during examination.
Proctitis
Patients may have anal rash, itching, pain, and liquid discharge. It can be seen in homosexual men, or caused by infection of the anus from the urogenital tract by pathogen secretions.
Perianal inflammation
It is a local fibrous inflammation of the liver surface and adjacent peritoneum caused by Chlamydia trachomatis, causing adhesions of the liver and diaphragm muscles, causing pain in the right upper quadrant. Clinical manifestations are fever, pelvic pain, and anal pain.
Non-gonococcal urethritis laboratory test
NGU laboratory tests mainly refer to the etiology and serology of Chlamydia trachomatis and Mycoplasma solani.
Non-gonococcal urethritis with direct immunofluorescence
The direct immunofluorescence method is to label specific chlamydia monoclonal antibodies with fluorescein and then check the chlamydia in the specimen. If there is a chlamydia antigen (inclusion body or primordia) in the specimen, it is combined with the antibody, and apple green fluorescence can be seen under a fluorescence microscope. . When the number of Chlamydia protozoa in one smear is 10 or more, the result is judged as positive. The sensitivity and specificity of this test can reach 80% ^-95%, respectively.
Non-gonococcal urethritis enzyme immunoassay
Enzyme immunoassay was used to detect the chlamydia antigen in the urogenital tract specimens of patients, and the judgment results were more objective. The sensitivity of this test was 60% -90%, and the specificity was 92% -97%.
3. Chlamydia culture Chlamydia is an obligate intracellular parasite that can grow and proliferate only in living cells. The commonly used cells in the laboratory are McCoy cells and Heh229 cells. The specimens taken must contain live cells. Therefore, the cotton swabs must be inserted in the columnar epithelial area, rotated and placed for 20 seconds, so that the swabs absorb more cells. Cell culture is the gold standard method for the diagnosis and identification of Chlamydia trachomatis with high sensitivity and specificity. However, certain conditions are required, and the operation is complicated and time-consuming.
Isolation of non-gonococcal urethritis mycoplasma
Isolation and culture of Mycoplasma avenae Mycoplasma avenae can grow in artificial medium containing urea, decompose urea to produce ammonia, make the medium alkaline, and the indicator in the medium changes from yellow to red. Therefore, if the specimen is inoculated in a liquid medium, the liquid medium changes from yellow to red, and the liquid is still clear, there may be mycoplasma growth. At this time, the culture was aspirated a little, diluted and inoculated into a solid or semi-solid medium, and cultured for 3-5 days. During the examination, first stained with Di-errs staining solution, and then observed with a low-power microscope. If colonies showing "fried eggs" were seen, the specimens were positive.
5. Polymerase chain reaction (PCR) and ligase chain reaction (LCR), because of their high sensitivity and specificity, can be used not only for urethral or cervical swabs for examination
Diagnosis and differential diagnosis of non-gonococcal urethritis
1. History of unclean sex or spouse infection within 1-3 weeks. History of unclean sex, incubation period and symptoms. 2. Smear and culture of urethral secretions exclude gonococcus, candida and other bacterial infections. The smear has a large number of white blood cells, more than 10-15 times / 400 times, and more than 5 times / 1000 times microscopic examination. 3 Examination or culture of urethral secretions or cervical smears, monoclonal chlamydia fluorescent antibodies. Specimen collection method: Males do not urinate for more than 2 hours. Cotton swabs are inserted into the urethra 2-4 cm, gently rotated for 5 s, placed for 2-3 s, and then removed for cultivation. The female fully exposed the cervix with a speculum. The first swab wiped off the surface secretions of the cervix. The second swab was inserted into the cervical 1-2cm, rotated for 10s, stopped for 2-3s, and the swab was removed without touching the vaginal wall. . Non-gonococcal urethritis diagnostic criteria (1) have a history of unclean sexual contact. (2) The incubation period is 1 to 3 weeks. (3) Common clinical manifestations: Male patients often have serous or mucopurulent discharge from the urethral orifice or painful urination. Female patients often have frequent urination and difficulty urinating. For example, when it spreads to the cervix, it shows inflammation and erosion, increased secretions, anti-pruritic vagina and external, but some patients are asymptomatic. (4) Secretion smears and cultures without gonorrhoeae, secretion smears, Gram staining or unfolding for the first time (or 2 to 3 hours after urine), do centrifugal sedimentation, take the sediment for inspection, and use a high-power microscope for each If there are more than 10-15 polymorphonuclear leukocytes in the visual field, chlamydia or mycoplasma can be detected in culture. Non-gonococcal urethritis (NGU) is a collective name for urethritis caused by sexually transmitted pathogens other than gonococci. There are many clinical urethritis caused by sexual contact. The urinary tract secretion soil film and microscopic examination can not find gonococcus, and treatment with penicillin is not effective. These lesions are caused by chlamydia, mycoplasma, or fungi, etc. Can be collectively referred to as non-gonococcal urethritis. Because NGU's pathogens are often cross-infected with gonococci, and some gonorrhea patients have undergone a course of anti-gonococcal treatment, although the symptoms of gonorrhea urethritis have improved, they have not been cured, and no gonococci have been found during the inspection. It is urethritis after gonorrhea. In recent years, the number of NGU cases has been increasing and often coexist with gonorrhea. The incidence rate of NGU has now ranked first in sexually transmitted diseases. The disease also occurs in the youthful period.
Non-gonococcal urethritis treatment
After the diagnosis of non-gonococcal urethritis, a broad-spectrum antibiotic therapy is used, and the continuous and uninterrupted medication is emphasized, and regular, quantitative and thorough treatment is required. The re-examinations were negative again 10-20 days after treatment, and the clinical symptoms disappeared as the cure. The course of treatment required for this disease is longer.
Western medicine for non-gonococcal urethritis
Recommended protocol of the STD Control Manual of the Ministry of Health and Epidemic Prevention of the People's Republic of China (1) Recommended protocol for the treatment of uncomplicated urethritis and cervicitis in adults caused by chlamydia or mycoplasma: doxycycline 100 mg, orally, 2 daily For 7 days in a row; or tetracycline hydrochloride 500 mg orally, 4 times a day, at least 7 days, usually 2 to 3 weeks. It can also be changed to 250mg 4 times a day until 21d after 7d; or 100mg minocycline orally and 2 times a day for 10d; or 250mg oxytetracycline orally and 4 times a day for 7d Because pregnant women should not use tetracycline, they can be replaced with erythromycin with less liver damage. The erythromycin treatment dose is 500mg orally, 4 times a day, even for 7 days. In addition to oral medicine, Jiaoyan Jieyin lotion containing PHMB bactericidal ingredients was also used for internal and external washing. (2) Patients' sexual partners should also be examined and treated. (3) Due to the current epidemic of penicillin-resistant Neisseria gonorrhoeae, and as many as 45% of gonorrhea patients are infected with Chlamydia at the same time as Neisseria gonorrhoeae, and currently there is no rapid and reliable method for detecting Chlamydia, so the use of cephalosporin Sodium (250mg, 1 intramuscular injection) and doxycycline (100mg, orally, 2 times a day for 7d> combined treatment of gonorrhea and NGU. The standard of cure is the patient's conscious symptoms disappeared, no urethral discharge, urine sediment No white blood cells. NGU has a good prognosis after treatment, and the symptoms disappear without any sequelae.
Chinese medicine treatment of non-gonococcal urethritis
Chinese medicine formula Bladder hot and humid type: Composition: Raw land, Mutong, talc, licorice, tincture, cork, diarrhea, gardenia, Lulutong Cards: red tongue, thin yellow tongue coating, slippery pulses, short, red and tingling urine, urination Unfavorable, urethral lipstick, burning sensation, tingling, itching, frequent urination, urgency, dysuria, perineum, anus, lower abdominal discomfort. Note: Urinary pain drama plus "stone reed, dandelion, zihuadiding", etc., and those with lower abdominal pain plus "chuanxiongzi, black medicine, white peony" and so on. 2. Bladder qi stagnation type: Composition: Qumai, Coptis chinensis, Rhubarb, Mutong, Platycodon grandiflorum, Yuanhu, morning glory, coriander shell, cricket live, dry musk, abdomen, angelica, cinnamon Main symptoms: thin and white tongue coating, heavy pulse , Dysuria, dysuria, unclean dripping, perineal bulging, lower abdomen discomfort, epididymis and prostate, intermittent pain. Note: those with lower abdominal pain are given "Wuyao, Chinese bellflower, Chuanxiongzi", those with back pain are added with "Achyranthes bidentata, Chuanchuan, and dog spine". 3 Bladder cold and wet type: Composition: Chinese yam, cumin, angelica, white peony, pepper flower, polyporus, Alisma, Atractylodes, Poria, Guizhi Main card: thin white tongue coating, slow and slow pulse, weak constitution, afraid of cold, Frequent urination, low back pain, difficulty urinating, dripping unclean, dysuria, urgency, frequent urination are not obvious, perineal bulging, lower abdomen discomfort and so on. Note: Those who have poor appetite with chest tightness and nausea add "Cangzhu, Chenpi, Pinellia." 4. Deficiency cold spleen and kidney qi deficiency type: Composition: Codonopsis, Huanghua, Atractylodes, Licorice, Angelica, Bupleurum, Cimicifuga, Chenpi, Alisma, Psyllium, Radix, Black Medicine, Rhododendron, Zhiren Ren Evidence: fat tongue, pale and greasy tongue coating, pulse deficiency and lateness, epididymis and prostate discomfort, urinary turbidity, dripping out, leucorrhea, draining urine, slight pain in the perineum, worsening perineal swell, worsening abdominal pain Sleepy, weak limbs. 5. Deficiency of kidney and yin deficiency: Composition: Ejiao, Talc, Habitat, Poria cocos, Flea Hook, Silver Flower, Purple Flower Didin, Cork, Anemarrhena asparagus, Poria, Cinnamon, Cinnamon Main symptoms: Cracked tongue body, red tongue tip, tongue coating Less or peeling, the number of pulses is small. Urinary tract swelling, urinary tingling, itching, etc., light and heavy, perineal swell increased, vas deferens thickened, complicated with chronic prostatitis and epididymis, waist and leg drowsiness, lower abdomen swelling, weight loss, fever in hands, feet, heart, mouth Dry, weak urine, frequent urination, dry stool. Note: Those who have pain are added: red peony, Yuanhu, platycodon, chuanxiongzi; thickened vas deferens are added: sea pumice stone, madder; those who have indurated testicles are added: orange core, prunella vulgaris, yuanshen, zelan, safflower. 6. Qi and blood double deficiency type composition: Codonopsis, yellow flower, lotus meat, Asparagus, Ophiopogon, raw land, mature land, middle knee, ground bone skin, Poria, Psyllium seed, Zhigancao Main card: Tongue fat and Shaojin, Thin tongue, thin and weak pulses, frequent urination, endless dripping, vulvar burning, itching, leucorrhea, strong odor, lower abdomen, swelling, backache, dullness, restlessness, fatigue, sore limbs, constipation or thinness, but local Symptoms are more serious.
Precautions for the treatment of non-gonococcal urethritis
(1) No alcohol is allowed during treatment. (2) Follow-up should be performed after completing a course of treatment. (3) Whether the patient is treated on time and according to the amount. Because the treatment of non-gonococcal urethritis is different from that of gonorrhea, which can achieve short-term adequate treatment, and the number of medications is long and the duration is long, patients are likely to forget to take the medication due to business reasons, or they will stop taking it after 1 to 2 days. Efficacy or relapse. Do not rush to change drugs at this time. (4) At present, as many as 45% of patients with gonorrhea are infected with gonococcus as well as chlamydia and mycoplasma. Therefore, in the treatment of gonorrhea, a combined treatment of non-gonococcal urethritis can be adopted. In addition, no matter Chinese medicine or western medicine is used to treat NGU, sterilization lotion, such as Jiaoyan Jieyin lotion, should be used in combination to directly kill the germs and receive the effect of double-edged swords. (5) Sexual partners should be treated at the same time if they are infected. After treatment, the patient's symptoms persist, or the symptoms recur after the symptoms disappear. The most likely cause is that the sexual partner has not been treated. Sexual intercourse with a sexual partner without cure, the germs are re-transmitted to the patient by an untreated sexual partner. Note that 40% of patients with non-gonococcal urethritis are asymptomatic. Therefore, not only the patients themselves should be treated, but their sexual partners should also receive preventive medication. The method is the same as that of the patient. For pregnant women, it can be treated with erythromycin or amoxicillin. (6) For patients who have not been cured in multiple hospitals. To understand the condition and course of treatment in detail, if there is no improvement or ineffectiveness according to the regular therapy, another method should be changed, or even combined treatment. Do not use similar antibiotics in combination therapy. (7) If it is confirmed that patients with Chlamydia trachomatis urethritis, it can be effective to extend the course of treatment to 4-6 weeks when re-treatment. (8) There have been many reports that the decomposed mycoplasma urealyticum is resistant to tetracycline. If this is suspected, other antibiotics should be used in time. (9) If the patient has recurrent attacks, he should be alert to complications such as prostatitis, etc., and appropriate bacteriological examination should be done and treated in time. (10) Conditional medical units should conduct detailed clinical and bacterial investigations and carry out targeted treatment for each patient, especially those with relapses, so that they can be completely cured. (11) The clinical manifestations are inconsistent with the symptoms of non-gonococcal urethritis, and the test does not detect the pathogen. Consider whether it is a neurosis. At this time, it is necessary to explain, comfort and use sedative drugs. it is good. (12) If it is trichomoniasis, mold or other rare diseases, especially mycotic urethritis, do not blindly add medicine, otherwise it will be more harmful to the patient, and should be identified and treated symptomatically. (13) Antibiotics should not be abused in the treatment of non-gonococcal urethritis. If most penicillin drugs are not effective for chlamydia and mycoplasma, they should not be used generally. Sulfonamide is effective for Chlamydia but not for Mycoplasma, streptomycin spectinomycin is not effective for Chlamydia, it is effective for Mycoplasma, gentamicin, neomycin, and polymyxin are not effective for Chlamydia.
Nursing method of non-gonococcal urethritis
1. Promote cleanliness and self-love to eradicate sexual confusion. 2. The patient must not have sex with anyone until he is cured. 3 Personal infection prevention is similar to gonorrhea and vaginitis. Women's daily cleaning of private parts can use Jiaoyan weak acid female care solution, pH4 weak acid female care solution can maintain the self-purifying effect of the vagina. 4 Patients should use special bathtubs, bath towels, and underwear to boil and disinfect frequently. 5. Tongzhi of sexual partners.
Non-gonococcal urethritis harm
Although non-gonococcal urethritis has milder symptoms than gonorrhea, the harm is not less than that of gonorrhea. Due to the mild symptoms, many patients have lost the optimal period of treatment, which makes the treatment very difficult. The disease, especially in women, is extremely mild, and women with infection are often left untreated because of the mild symptoms, which increases the chance of the disease spreading. . In addition to causing urethritis, more than half of women with this disease have comorbidities, such as endometritis, salpingitis, ectopic pregnancy, infertility and abortion. Onset of urinary pain, urethral discomfort, itching of the urethra, burning sensation or tingling, urethral swelling, urethral discharge, thinness and so on. As the disease progresses, the above symptoms will gradually worsen. Improper treatment or treatment may cause recurrent illness, causing premature ejaculation, acute epididymitis, prostatitis and other diseases, and severely cause male infertility.
Health knowledge of non-gonococcal urethritis
Eliminate unclean sex and correct contraception
The estrogen in birth control pills has the effect of promoting mold invasion. If non-gonococcal urethritis occurs repeatedly, try not to use drugs for contraception. Feminine care liquid is more suitable for daily cleaning and maintenance
Frequent use of medicine size lotion, disinfection pads, etc., is easy to destroy the weak acidic environment of the vagina. The weak acidic environment of the vagina can maintain the self-cleaning function of the vagina. Ph4 weak acid formula of female care solution is more suitable for daily cleaning and maintenance. Pay attention to public place hygiene
Hygiene in public bathhouses is also very important. Wash basins are not recommended, and clothes should be stored separately. There may be a lot of germs hidden in public. When going out, don't use hotel tubs, wear long pajamas, use toilet paper in front of toilets, etc. At the same time, Jiaoyan's personal cleaning and care products can be used. Feminine hygiene wipes are easy to carry. Partner Tongzhi
If you are infected with mycotic vaginitis, it is not only you that need to be treated, but you and others. When you usually use the female care solution daily, don't worry about preparing a male care solution for him to use. Wear cotton underwear
Tight chemical fiber underwear will increase the temperature and humidity in the vagina, which is a "living" environment where molds clap their hands! Or choose cotton underwear!
Non-gonococcal urethritis diet
Non-gonococcal urethritis diet should be avoided
Non-gonococcal urethritis diet should try to avoid spicy products: such as heavy drinking, spicy hot pot, raw garlic, ginger, green onions, pepper, etc., so as not to aggravate internal heat, but non-gonococcal urethritis and allergic diseases Different, there is no excessive requirement for the intake of heterologous proteins such as eggs, milk, fish, beef, mutton, etc. That means these foods should be edible. Drinking plenty of water is good for urethritis. If there is sex Your partner should treat them at the same time.
Non-gonococcal urethritis food therapy
1. Use 50 grams of wolfberry, 100 grams of Poria, 100 grams of black tea. The wolfberry and Poria are co-ground into coarse powder. Take 5-10 grams each time, add 6 grams of black tea, and brew with boiling water for 10 minutes. Drink 2 times daily. 2. Take 50 grams of red beans and 50 grams of corn. Cook it and drink it once a day for 20 days. 3 Use 10 grams of light bamboo leaves, 50 grams of fresh reed roots, and 10 grams of wild chrysanthemums. Decoction for 20 days as a course of treatment. 4 Take 30 grams of Tongcao and 30 grams of Houttuynia cordata. On behalf of tea, any number of times. 5. Use 10 grams of Coptis chinensis, 30 grams each of Hedyotis diffusa, Portulaca oleracea, 15 grams each of Poria cocos, Sophora flavescens, Baixianpi, Qumai, Amaranth, Rhizoma Acipenser, Sichuan Achyranthes bidentata and 6 grams each of Mutong and Licorice. Take 1 dose daily and decoction twice. 6. Take 10 grams of winter colza, root or raw licorice. Decoction. 7. Use 30--50 grams of kapok, the amount of white sugar. Fry two and a half bowls with water to one bowl. 8. Take 200 grams of pig bladder, 60--100 grams of fresh plantain (20-30 grams for dry products). Boil the soup and season with a little salt. 9. 30 grams each of Poria cocos, Sophora flavescens, and 20 grams each of Cork and Geoderma. 1 dose daily, decoction and washing.
Non-gonococcal urethritis prevention
NGU is one of sexually transmitted diseases. The precautionary principles and measures are the same as other sexually transmitted diseases. Promote the prevention and treatment of sexually transmitted diseases widely; Screen high-risk populations and detect asymptomatic infections through sexually active young women through gynecological examinations and family planning clinics; Regular treatment of patients is needed to control the source of infection and prevent Complications. After completing the treatment, they should go to the hospital for review; sexual partners should also be examined and treated, and patients and sexual partners should be required to avoid sexual contact; If symptoms persist or there is recurrence after symptoms disappear, they should go to the hospital immediately Examination; Promote the use of diaphragm sex tools.
