Nongonococcal urethritis

Disease Description (Causes and Symptoms)

• Definition: Nongonococcal urethritis (NGU) refers to inflammation of the urethra caused by pathogens other than Neisseria gonorrhoeae. Symptoms are more commonly apparent in men.
• Major causative pathogens: Chlamydia trachomatis, Ureaplasma spp., Mycoplasma genitalium, other enteric bacteria (e.g., E. coli), Trichomonas, Candida, etc. Sexual contact is the primary route of transmission; rarely, transmission may occur through insertion of medical devices, urethral injury, childbirth, and other routes.
• Pathophysiology (brief): Pathogens infiltrate and multiply in the urethral mucosa, causing localized inflammation and resulting in neutrophil infiltration, mucoid·viscous discharge, dysuria, burning sensations, and other symptoms. Some pathogens (such as M. genitalium) are prone to becoming chronic due to the development of antibiotic resistance.
• Main symptoms:
  • Men: Sharp pain·burning during urination, urethral discharge (clear or mucoid), urinary frequency·difficulty urinating, urethral itching
  • Women: Increased nonspecific vaginal discharge, vulvar itching, dysuria, lower abdominal discomfort, painful intercourse, sometimes no symptoms
• Incubation period: Generally varies from several days to several weeks (approximately 1 week to 1 month)

Treatment Methods

• Empiric treatment before diagnosis (depending on the clinical situation) and pathogen-specific standard treatment after confirmation are recommended
• Standard pharmacotherapy (based on current recommendations)
  • First-line options
    • Doxycycline 100 mg PO every 12 hours for 7 days (preferentially recommended for men and nonpregnant women)
    • Or Azithromycin 1 g PO as a single dose (an alternative option, although its use as monotherapy has been reduced in some guidelines; caution is needed because of the issue of M. genitalium resistance)
  • When Mycoplasma genitalium is suspected or confirmed
    • Initial treatment: doxycycline 100 mg PO every 12 hours for 7 days (low eradication effect)
    • When resistance is suspected/confirmed or infection persists after doxycycline: moxifloxacin 400 mg PO for 7–14 days (refer to resistance test results and national guidelines)
  • When gonococcal co-infection cannot be excluded or is suspected
    • Ceftriaxone 500 mg IM as a single dose (adjust the dose according to body weight; check national guidelines)
• Additional measures
  • Identify the pathogen through etiologic testing (NAAT/PCR) and perform antibiotic susceptibility testing (if possible)
  • Concurrent STI testing: HIV and syphilis (serologic testing) are recommended
  • Partner testing·treatment (recent sexual partners must be notified and treated)
  • Abstain from sexual intercourse: avoid intercourse until treatment is completed and symptoms have resolved (follow guidelines, such as the recommended minimum period of 7 days after treatment completion)
• Lifestyle management and precautions
  • Monitor for allergies·side effects while taking the medication (nausea, diarrhea, photosensitivity, etc.)
  • During pregnancy: doxycycline is contraindicated (risk to the fetus); use of safe alternatives such as azithromycin is recommended
  • Re-evaluation if symptoms persist·recur: another pathogen (e.g., M. genitalium) or antibiotic resistance may be suspected
  • Reinfection from untreated partners is possible → testing·treatment of all recent sexual partners is necessary
• In emergencies (symptoms requiring emergency medical care)
  • High fever·general malaise, severe testicular pain (suspected epididymitis), copious purulent discharge, symptoms during pregnancy

Outpatient Visit Checkpoints (Preparation Items and Example Questions)

• Items to prepare (bring with you)
  • List of current medications·supplements (medication packets, if possible)
  • Previous STI test results (if available)
  • Time of symptom onset and progression (symptom diary: severity of pain during urination, presence·color of discharge, etc.)
  • Recent sexual partner information (date of last sexual contact, whether the partner has symptoms)
  • Allergy history (especially antibiotics)
  • Possibility of pregnancy or whether pregnant (women)
• Items to check in advance at the outpatient visit (patient self-check)
  • When did the symptoms begin?
  • Have there been changes in the color·amount·odor of the discharge?
  • Have you recently undergone testing or treatment for another STI?
  • Frequency of sexual intercourse and number of partners, and whether condoms were used
• Example checklist questions (for submission to the doctor)
  • Number of sexual partners in the past 3 months and date of last sexual contact
  • Possibility of pregnancy (women), whether breastfeeding, etc.

Examples of General Questions to Ask the Doctor

• What are the main side effects of this medication, and what precautions should I take?
• How long will it take to receive the test results, and how will the treatment plan change depending on the results?
• When can I resume sexual intercourse after treatment?
• What are the risks of complications and the prognosis for this disease?
• Should I also be tested for other sexually transmitted infections (HIV·syphilis, etc.)?

Examples of Disease-Specific Questions

• Do I need testing for M. genitalium (including genetic resistance testing) in my case? Which medication will be used depending on the results?
• Even though my recent partner has no symptoms, should we both be tested and treated? (What scope and timing are recommended?)
• I am pregnant; which medications are safe?

(Note: Diagnosis·treatment may vary depending on the latest local guidelines, test availability, and individual medical history, so consult the attending physician during your visit to develop an individualized plan.)