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Urethritis can be caused by a number of organisms, including Neisseria gonorrheae, Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma genitalium, Trichomonas vaginalis, Herpes simplex virus, and Candida albicans, and by a number of non-infectious causes, including urethral stricture, foreign bodies, trauma, Reiter's syndrome, and various autoimmune and allergic conditions.
Of these many causes, the vast preponderance of cases are due to either gonorrhea or chlamydia. It is currently estimated that 50% of NGU cases are caused by chlamydia, with the remainder due to other causes.
Historically, it has been easy to test for the presence of gonorrhea by viewing a Gram's stain of the urethral discharge under a microscope: the causative organism is distinctive in appearance. Thus, one of the major causes of urethritis can be identified by a simple common test, and the distinction between gonococcal and non-gonococcal urethritis arose historically for this reason.
Identifying chlamydia, the other major cause of urethritis, has required more sophisticated technology, but is now more widely available. These two tests combined identify the cause of most treatable forms of urethritis. If tests for gonorrhea and chlamydia are negative, and the cause of the urethritis has not been otherwise identified, the term non-specific urethritis (NSU) is used. The terms "NGU" and "NSU" are sometimes used inconsistently, but these are the most common meanings in the modern era of treatment.
Treatment is based on the prescription and use of the proper antibiotics depending on the strain of the ureaplasma.
Because of its multi-causative nature, initial treatment strategies involve using a broad range antibiotic that is effective against chlamydia (such as doxycycline). It is imperative that both the patient and any sexual contacts are treated. Women who are infected with the organisms that cause NGU may develop pelvic inflammatory disease. If symptoms persist, follow-up with a urologist may be necessary to identify the cause.
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