American Medical Association Family Medical Guide - American Medical Association [252]
Nongonococcal Urethritis
Nongonococcal urethritis (NGU) is a sexually transmitted disease (STD) that causes inflammation of the urethra (the tube that carries urine from the bladder out of the body). Nongonococcal means that the infection is not caused by the type of bacteria that causes gonorrhea (see page 480). Most cases are caused by the bacterium Chlamydia trachomatis.
NGU is usually transmitted through contact with the mucous membranes in the penis, vagina, mouth, or anus of an infected person during sexual activity. Other possible causes of NGU include urinary tract infections (see page 803), inflammation of the prostate gland (bacterial prostatitis; see page 831), narrowing of the urethra (urethral stricture; see page 837), tightening of the foreskin (phimosis; see page 839), and having a urinary catheter (a thin, flexible tube used to drain urine from the bladder).
In men, untreated NGU can lead to inflammation of the epididymis (epididymitis; see page 827), which can result in infertility (see page 494), arthritis (see page 996), conjunctivitis (see page 1038), and skin lesions. In women, untreated NGU can cause pelvic inflammatory disease (see page 871), which, in turn, can lead to ectopic pregnancy (see page 523), infertility, chronic pelvic pain, chronic inflammation of the urethra (urethritis; see page 878), inflammation of the vagina (vaginitis; see page 879), or, in a pregnant woman, miscarriage (see page 522). In both men and women, untreated NGU resulting from anal sex can cause severe inflammation of the rectum.
Symptoms
Often, NGU does not produce symptoms, but an infected person can still pass the infection to his or her sex partner. In men, possible symptoms can include a discharge from the penis, pain or burning when urinating, and itching, irritation, and tenderness. In women, possible symptoms include a painful, burning sensation during urination, and a frequent need to urinate that produces only a small amount of urine. Other symptoms in women include abdominal pain, a heavy vaginal discharge, bleeding between periods, or heavy menstrual bleeding. In both men and women, an anal infection can cause rectal itching and a discharge or pain during bowel movements. An oral infection usually does not produce symptoms, but some people can have a sore throat.
Diagnosis
A diagnosis of NGU is based on the symptoms, a physical examination, the results of urine tests, and laboratory analysis of any discharge. A doctor uses a swab to obtain a sample of discharge from a man’s urethra or a woman’s cervix for examination under a microscope. He or she usually orders a blood test to rule out gonorrhea.
Treatment
NGU is usually treated with an antibiotic such as azithromycin or doxycycline. You and your sex partner should be treated at the same time to help ensure that the infection is eliminated. Your doctor will ask you to avoid sexual contact until you have completed treatment and have no symptoms. Ask your doctor when you can safely resume sexual activity. Note that even after successful treatment, NGU may recur. If symptoms return, see your doctor immediately.
Genital Herpes
Genital herpes is a common, incurable sexually transmitted disease (STD) caused by the herpes simplex virus. One out of five Americans over age 12 has genital herpes. A similar virus that causes cold sores (see page 744) in the mouth also causes about 15 percent of cases of genital herpes, usually as a result of oral-genital contact. Genital herpes can be transmitted from one person to another through touching, kissing, and vaginal, oral, or anal sex.
In a person whose immune system has been weakened, such as from undergoing chemotherapy (see page 23), the herpes virus can spread throughout the body via the bloodstream and infect other organs and tissues. If a pregnant woman has an outbreak of genital herpes near the time of delivery, an obstetrician will recommend cesarean section (see page 534) to avoid infecting