From the Guidelines
Patients with NGU symptoms should be treated with Azithromycin 1 g orally in a single dose or Doxycycline 100 mg orally twice a day for 7 days, as these regimens have been shown to be effective in managing the condition. Non-gonococcal urethritis (NGU) symptoms typically include painful urination (dysuria), increased urinary frequency, urethral discharge (usually clear or white), and urethral itching or discomfort 1. Some patients may experience mild discomfort in the lower abdomen or testicles. However, up to 50% of men with NGU may be asymptomatic. The treatment regimens recommended are based on the guidelines provided by the Centers for Disease Control and Prevention 1, which suggest that single-dose regimens have the advantage of improved compliance and directly observed therapy (DOT).
Key considerations in managing NGU include:
- Testing for chlamydia is strongly recommended due to the increased utility and availability of highly sensitive and specific testing methods 1
- Partners of patients treated empirically should be evaluated and treated 1
- Patients should be instructed to return for evaluation if symptoms persist or recur after completion of therapy 1
- Symptoms alone, without documentation of signs or laboratory evidence of urethral inflammation, are not a sufficient basis for re-treatment 1
Alternative regimens, such as Erythromycin base 500 mg orally four times a day for 7 days, or Ofloxacin 300 mg twice a day for 7 days, may be considered, but the first-line treatment options are preferred due to their efficacy and compliance advantages 1. Patients should abstain from sexual intercourse until 7 days after therapy is initiated, and all sex partners within the preceding 60 days should be referred for evaluation and treatment 1.
From the Research
NGU Symptoms
- The symptoms of non-gonococcal urethritis (NGU) include discharge, dysuria, and/or urethral discomfort, but it may also be asymptomatic 2.
- The diagnosis of urethritis is confirmed by demonstrating an excess of polymorpho-nuclear leucocytes (PMNLs) in a stained smear 2.
- An excess of mononuclear leucocytes in the smear indicates a viral etiology 2.
Causes of NGU
- NGU is caused by various microorganisms, including Chlamydia trachomatis, Mycoplasma genitalium, Ureaplasma urealyticum, Trichomonas vaginalis, anaerobes, Herpes simplex virus (HSV), and adenovirus 2.
- Approximately 20-50% of cases are due to infection with Chlamydia trachomatis, and 10-30% are due to Mycoplasma genitalium 2.
- Up to half of the cases are non-specific, meaning that no specific cause can be identified 2.
Treatment of NGU
- Treatment options for NGU include doxycycline 100 mg twice a day for one week, or azithromycin 1 gram single dose or 1.5 gram distributed in five days 2.
- Azithromycin has been shown to be effective in treating NGU, with a clinical cure rate of 86% in symptomatic patients and 100% in asymptomatic patients 3.
- Doxycycline is also effective, but suboptimal adherence to the 7-day course of therapy may contribute to poor treatment outcomes 4.
- Single-dose azithromycin regimens have been shown to be well-tolerated and effective in eradicating the estimated and potential pathogens of NGU 5, 3, 6.