Non-gonococcal urethritis

　　Complications of non-gonococcal urethritis in males
　　Prostatitis
　　During the acute phase, urination is accompanied by severe pain, which radiates to the urethra, scrotum, and buttocks. There is a feeling of rectal坠胀. Difficulty in urination and painful erections of the penis may also occur, with a few cases accompanied by fever or general malaise. Digital rectal examination shows enlargement and tenderness of the prostate. Transparent filamentous substances or grayish-white clumps may appear in the urine. Most patients initially present with chronic symptoms, such as discomfort during urination, mild pain or acid-sensation in the perineum, inguinal, upper pubic symphysis, and lumbar and sacral regions. Examination shows an asymmetrical enlargement, hardening, or nodules of the prostate.
　　Epididymitis
　　Acute and chronic forms can be distinguished. Acute non-gonococcal epididymitis is less common, with an incidence rate of 1%, often coexisting with urethritis, mostly unilateral. It is characterized by swelling and hardening of the epididymis, thickening and tenderness of the vas deferens, and may also include scrotal edema. During the chronic phase, there may be nodules at the tail of the epididymis and thickening of the spermatic cord. Acute attacks are often triggered by factors such as excessive sexual activity and alcoholism. The serum antibody level is significantly elevated during epididymitis, so serological examination is of great significance for the diagnosis of epididymitis.
　　Seminal vesicle and epididymis inflammation
　　Seminal vesicle and epididymis inflammation: Often coexists with prostatitis. Its clinical manifestations are similar to prostatitis, with symptoms such as seminal blood, pain during ejaculation, and increased seminal emission. Digital rectal examination may find tenderness, swelling, or fibrous strands on both sides of the upper boundary of the prostate.
　　Reiter's disease
　　Reiter's disease: Patients have urethritis, conjunctivitis, and polyarticular symmetrical arthritis. Some patients have superficial erosions on the glans penis and prepuce, slightly elevated edges, merging into multi-loop, known as circumcised glans. The affected joints are most common in the knee, ankle, and elbow. Joint lesions can last for several months, and occasionally myocarditis, pleurisy, and polyneuritis may occur. Chlamydia can sometimes be detected in synovial fluid. The titer of anti-chlamydia antibodies in serum also increases. However, Reiter's syndrome may be caused by various reasons, and chlamydia infection may be one of them.
　　Complications of Chlamydia trachomatis infection in women
　　Acute and chronic pelvic inflammatory disease
　　Acute pelvic inflammatory disease is manifested as fever, headache, loss of appetite, and lower abdominal pain, which may be accompanied by abdominal distension, nausea, and vomiting, etc. During examination, there is tenderness and rebound tenderness in the lower abdomen, tenderness of the uterine body, and limited mobility. There is tenderness on both sides of the uterus, and sometimes a mass can be palpated. In chronic pelvic inflammatory disease, the systemic symptoms are often not obvious, mainly manifested as lower abdominal distension and pain, lumbar pain, and increased leukorrhea. When the ovarian function is affected, menstrual irregularity may occur. Endometritis can cause increased menstrual volume, prolonged or shortened menstrual period, dull pain in the lower abdomen. The mobility of the uterine body is limited, and one or both fallopian tubes become thickened and fibrous. Sometimes a cystic mass can be palpated, and there is tenderness around it. Recurrence can lead to fallopian tube obstruction, resulting in infertility and ectopic pregnancy, abortion, preterm delivery, and stillbirth, etc.
　　Bartholin's gland inflammation
　　There may be erythema, edema, and local pain at the opening of the glands between the labia minora and the hymen. In severe cases, abscesses may occur. Chronic recurrence can form cysts, and the enlarged gland ducts and glands can be palpated during examination.
　　Rectal inflammation
　　Patients may have anal itching, pain, and purulent discharge. It may be seen in male homosexuals or due to the secretion of pathogens from the urogenital tract infecting the anus.
　　

　　8. Typical symptoms include urethral itching, accompanied by urgency, dysuria, and difficulty in urination, but the symptoms are milder than those of gonococcal urethritis.
　　7. Before long-term urination or the first urination in the morning, a small amount of mucous secretion may come out of the urethral orifice, and sometimes it is only manifested as crustal closure or dirty pants. A considerable number of people may have no symptoms at all.
　　6. Male patients may develop epididymitis. Female patients are not as typical as males, many patients may be asymptomatic, and generally they may develop urethritis, muco-purulent cervicitis, acute pelvic inflammatory diseases, and infertility, etc.

　　1. Abolish unclean sexual intercourse and practice correct contraception
　　Estrogens in birth control pills have a promoting effect on the invasion of fungi. If non-gonococcal urethritis occurs repeatedly, it is best not to use drug contraception.
　　2. Women's hygiene fluid is more suitable for daily cleaning and maintenance
　　Frequent use of medicated washes, disinfectant pads, and other products can easily destroy the weak acidic environment of the vagina. The weak acidic environment of the vagina can maintain the self-cleaning function of the vagina. Women's care liquids with a Ph4 weak acid formula are more suitable for daily cleaning and maintenance.
　　3、Pay attention to public place hygiene
　　The hygiene of public bathhouses is also very important. It is not recommended to take a bathtub, and clothes should be stored separately. Public places may hide a large number of pathogens. When traveling, do not use the hotel's bathtub, wear long pajamas, use toilet paper before using the toilet, etc. At the same time, personal cleaning and care products can be selected, and women's hygiene care wet wipes should be kept on hand.
　　4、Partner Treatment
　　If you are infected with candidal vaginitis, not only you but also your partner need to be treated for the expected therapeutic effect. In addition to using women's care liquids in daily life, also prepare a men's care liquid for men to use.
　　5、Wear cotton underwear
　　Tight synthetic underwear can increase the temperature and humidity locally in the vagina, which is a 'dwelling' environment that fungi are delighted with. So, choose cotton underwear instead! Therefore, please choose all-cotton underwear.

　　Routine examination methods include:
　　1. Direct Immunofluorescence Test
　　After marking specific chlamydia monoclonal antibodies with fluorescent dye, the chlamydia antigens in the specimen are detected. If chlamydia is present in the specimen, it will bind to the antibody, and apple green fluorescence can be observed under a fluorescence microscope. A positive result is obtained when there are more than 10 chlamydiae in a slide, with a specificity greater than 97% and a sensitivity of 70% to 92%.
　　2. Enzyme-linked Immunosorbent Assay (ELISA)
　　By detecting chlamydia antigens in the urogenital tract with a spectrophotometric phase contrast instrument, a color change is observed as positive, with results obtained within 24 hours. The sensitivity is 60% to 90%, and the specificity is 92% to 97%.
　　3. Chlamydia trachomatis culture
　　Chlamydia trachomatis is a obligate intracellular parasite that can only grow and reproduce in living cells. The commonly used cells for chlamydia culture are McCoy cells and Hela 229 cells, with a specificity of 99% to 100% and a sensitivity of 68.4% to 100%, which is currently the gold standard for diagnosing Chlamydia trachomatis. Chlamydia trachomatis is a microorganism that resides in columnar epithelial cells. The appropriate culture specimen is obtained by swabbing the urethra within 2 to 4 mm from the urethral orifice, rather than taking secretion or urine from the urethral orifice for culture.
　　4. Ureaplasma culture
　　By utilizing the principle that Ureaplasma can decompose arginine to produce ammonia and ferment glucose to produce acid, this method changes the arginine-containing broth culture medium to alkaline, changing the indicator color from yellow to red, and changes the glucose broth culture medium from pink to yellow. This method is simple, objective, and inexpensive, and has been widely used in clinical practice.
　　5. Polymerase Chain Reaction (PCR) and Ligase Chain Reaction (LCR)
　　Both sensitivity and specificity are superior to other methods, but attention should be paid to prevent false positives caused by contamination.

　　1、Avoid spicy foods

　　Spicy foods (such as chili, ginger, scallion, garlic, etc.) are prone to cause dryness and heat, leading to internal heat and toxicity, which may exacerbate the symptoms of this disease.

　　2、Avoid seafood

　　Fishy and pungent foods such as mandarin fish, yellow croaker, hairtail, black croaker, shrimp, crab, etc., can promote damp-heat, which is not conducive to the regression of inflammation, so they should be avoided.

　　3、Avoid sweet and greasy foods

　　Oily foods such as lard, fatty pork, butter, beef fat, mutton fat, etc., high-sugar foods such as chocolate, candies, sweet pastries, cream cakes, etc., these foods have the effect of increasing dampness and heat, and affect the treatment effect.

　　After the diagnosis of non-gonococcal urethritis, a broad-spectrum antibiotic therapy is adopted, and it is emphasized that the medication should be continuous and uninterrupted, regular, quantitative, and thorough treatment. A re-examination 10-20 days after treatment should show negative results again, and the disappearance of clinical symptoms is considered as cure. The treatment course required for this disease is relatively long.
　　Medication Treatment

　　According to the recommended scheme of the Health and Prevention Department of the Ministry of Health of the People's Republic of China:
　　The recommended treatment plan for adult uncomplicated urethritis and cervicitis caused by chlamydia or mycoplasma: doxycycline 100mg, oral, twice daily, for 7 consecutive days; or tetracycline hydrochloride 500mg, oral, four times daily, for at least 7 consecutive days, usually 2-3 weeks. It can also be changed to 250mg, four times daily, until 21 days; or metronidazole 100mg, oral, twice daily, for 10 consecutive days; or oxytetracycline 250mg, oral, four times daily, for 7 consecutive days. Due to the inappropriateness of tetracycline for pregnant women, it can be replaced with erythromycin, which has less liver damage, with a treatment dose of 500mg, oral, four times daily, for 7 consecutive days. In addition to oral medication, use of the Yanyan Clean Intimate Wash with PHMB bactericidal components for internal and external washing in combination with treatment.
　　The sexual partners of the patients should also be examined and treated.
　　Due to the prevalence of penicillin-resistant gonococcal strains and up to 45% of gonococcal patients also being infected with chlamydia while infected with gonococci, and the lack of a rapid and reliable method for detecting chlamydia, the combined treatment of gonorrhea and NGU with ceftriaxone sodium (250mg, intramuscular injection once) and doxycycline (100mg, oral, twice daily, for 7 consecutive days) is adopted.
　　The standard for cure is the disappearance of the patient's自觉 symptoms, no urethral discharge, no leukocytes in the urine sediment, and no sequelae.