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August 16, 1995, Vol 274, No. 7 >
ARTICLE | August 16, 1995

Evolving Strategies for Management of the Nongonococcal Urethritis Syndrome FREE

George P. Schmid, MD, MSc; Phil B. Fontanarosa, MD
[+] Author Affiliations

Reprint requests to JAMA, 515 N State St, Chicago, IL 60610 (Dr Fontanarosa).


JAMA. 1995;274(7):577-579. doi:10.1001/jama.1995.03530070075034
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References

Nongonococcal urethritis (NGU) is the most common sexually transmitted disease (STD) syndrome that occurs in men and accounts for an estimated 4 million to 6 million physician visits annually.1 As with other sexually transmitted infections, the clinical management of patients with NGU ideally should include accurate identification of the most likely causative agent; prompt administration of effective antimicrobial therapy to alleviate symptoms, eradicate the causative organism, and prevent secondary complications; and initiation of appropriate counseling and intervention for notification and treatment of sexual partners. Unfortunately, in caring for patients with NGU, these components of clinical management are not straightforward. Clinicians have difficulty identifying patients with NGU because many are asymptomatic and not all of the organisms that cause NGU are known. In addition, current therapies are not ideal, and appropriate counseling and partner notification are made difficult by uncertainties in each of these areas. Fortunately, the investigation by Stamm

REFERENCES

1 +
Centers for Disease Control and Prevention.  Recommendations for the prevention and management of Chlamydia trachomatis infections, 1993. MMWR Morbid Mortal Wkly Rep . 1993;;42( (suppl RR-12) ):1-39.
2 +
Stamm WE, Hicks CB, Martin DH, et al.  Azithromycin for empirical treatment of the nongonococcal urethritis syndrome in men: a randomized double-blind study. JAMA . 1995;;274:545-549.
3 +
Bowie WR.  Urethritis in males.  In: Holmes KK, Mårdh P-A, Sparling PF, Wiesner PJ, eds. Sexually Transmitted Diseases . 2nd ed. New York, NY: McGraw-Hill International Book Co; 1990;:627-639.
4 +
McCormack WM, Lee Y-H, Zinner SH.  Sexual experience and urethral colonization with genital mycoplasmas: a study in normal men. Ann Intern Med . 1973;;78: 696-698.
5 +
Krieger JN.  Trichomoniasis in men: old issues and new data. Sex Transm Dis . 1995;;83-96.
6 +
Taylor-Robinson D.  The history and role of Mycoplasma genitalium in sexually transmitted diseases. Genitourin Med . 1995;;71:1-8.
7 +
Centers for Disease Control and Prevention.  1993 sexually transmitted diseases treatment guidelines. MMWR Morbid Mortal Wkly Rep . 1993;;42( (suppl RR-14) ):1-102.
8 +
Hillis S, Nakashima A, Amsterdam L, et al.  The impact of a comprehensive chlamydia prevention program in Wisconsin. Fam Plann Perspect . 1995;;27:108-111.
9 +
Lossick J, DeLisle S, Fine D, Mosure D, Lee V, Smith C.  Regional program for widespread screening for Chlamydia trachomatis in family planning clinics.  In: Bowie WR, Caldwell HD, Jones RP, et al, eds. Chlamydial Infections: Proceedings of the Seventh International Symposium on Human Chlamydial Infections . Cambridge, England: Cambridge University Press; 1990;:575-579.
10 +
National Disease and Therapeutic Index (IMS America, Ltd), as quoted in: Division of STD/HIV Prevention. Sexually Transmitted Diseases Surveillance, 1993 . US Dept of Health and Human Services, Public Health Service. Atlanta, Ga:Centers for Disease Control and Prevention; 1994;.
11 +
Chernesky MA, Lee H, Schachter J, et al.  Diagnosis of Chlamydia trachomatis urethral infection in symptomatic and asymptomatic men by testing first-void urine in a ligase chain reaction assay. J Infect Dis . 1994;;170:1308-1311.
12 +
Shafer M-A, Schachter J, Moncada J, et al.  Evaluation of urine-based screening strategies to detect Chlamydia trachomatis among sexually active asymptomatic young males . JAMA . 1993;;270:2065-2070.
13 +
Gunn RA, Spitters CE.  Screening for Chlamydia trachomatis: a case for empirical treatment. JAMA . 1994;;271:1741-1742.
14 +
Genç M, Ruusuvaara L, Mårdh P-A.  An economic evaluation of screening for Chlamydia trachomatis in adolescent males. JAMA . 1993;;270:2057-2064.
15 +
Genç M, Domeika M, Mårdh P-A.  Cost-effectiveness of screening for Chlamydia using DNA amplification. JAMA . 1994;;271:1741.
16 +
Martin DH, Mroczkowski TF, Dalu ZA, et al.  A controlled trial of a single dose of azithromycin for the treatment of chlamydial urethritis and cervicitis. N Engl J Med . 1992;;327:921-925.
17 +
Lauharanta J, Saarinen K, Mustonen MT, Happonen HP.  Single-dose oral azithromycin versus seven-day doxycycline in the treatment of non-gonococcal urethritis in males. J Antimicrob Chemother . June 1993;;( (suppl E) ):177-183.
18 +
Lister PJ, Balechandran T, Ridgway GL, Robinson AJ.  Comparison of azithromycin and doxycycline in the treatment of non-gonococcal urethritis in men. J Antimicrob Chemother . June 1993;;( (suppl E) ):185-192.
19 +
Drug Topics Red Book . Montrose, NJ: Medical Economics Co; 1995;.
20 +
Sclar DA, Tartaglione TA, Fine MJ.  Overview of issues related to medical compliance with implications for the outpatient management of infectious diseases. Infect Agents Dis . 1994;;3( (5) ):266-273.
21 +
Katz BP, Zwickl BW, Caine VA, Jones RB.  Compliance with antibiotic therapy for Chlamydia trachomatis and Neisseria gonorrhoeae. Sex Transm Dis . 1992;;19: 351-354.
22 +
Haddix A, Hillis S, Kassler W.  The cost-effectiveness of azithromycin for Chlamydia trachomatis infections in women. Sex Transm Dis . In press.
23 +
Wong ES, Hooton TM, Hill CC, McKevitt M, Stamm WE.  Clinical and microbiological features of persistent or recurrent nongonococcal urethritis in men. J Infect Dis . 1988;;158:1098-1101.
24 +
Jones RB, Van Der Pol B, Martin DH, Shepard MK.  Partial characterization of Chlamydia trachomatis isolates resistant to multiple antibiotics. J Infect Dis . 1990;; 162:1309-1315.
25 +
Hooton TM, Wong ES, Barnes RC, et al.  Erythromycin for persistent or recurrent nongonococcal urethritis. Ann Intern Med . 1990;;113:21-26.

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1 +
Centers for Disease Control and Prevention.  Recommendations for the prevention and management of Chlamydia trachomatis infections, 1993. MMWR Morbid Mortal Wkly Rep . 1993;;42( (suppl RR-12) ):1-39.
2 +
Stamm WE, Hicks CB, Martin DH, et al.  Azithromycin for empirical treatment of the nongonococcal urethritis syndrome in men: a randomized double-blind study. JAMA . 1995;;274:545-549.
3 +
Bowie WR.  Urethritis in males.  In: Holmes KK, Mårdh P-A, Sparling PF, Wiesner PJ, eds. Sexually Transmitted Diseases . 2nd ed. New York, NY: McGraw-Hill International Book Co; 1990;:627-639.
4 +
McCormack WM, Lee Y-H, Zinner SH.  Sexual experience and urethral colonization with genital mycoplasmas: a study in normal men. Ann Intern Med . 1973;;78: 696-698.
5 +
Krieger JN.  Trichomoniasis in men: old issues and new data. Sex Transm Dis . 1995;;83-96.
6 +
Taylor-Robinson D.  The history and role of Mycoplasma genitalium in sexually transmitted diseases. Genitourin Med . 1995;;71:1-8.
7 +
Centers for Disease Control and Prevention.  1993 sexually transmitted diseases treatment guidelines. MMWR Morbid Mortal Wkly Rep . 1993;;42( (suppl RR-14) ):1-102.
8 +
Hillis S, Nakashima A, Amsterdam L, et al.  The impact of a comprehensive chlamydia prevention program in Wisconsin. Fam Plann Perspect . 1995;;27:108-111.
9 +
Lossick J, DeLisle S, Fine D, Mosure D, Lee V, Smith C.  Regional program for widespread screening for Chlamydia trachomatis in family planning clinics.  In: Bowie WR, Caldwell HD, Jones RP, et al, eds. Chlamydial Infections: Proceedings of the Seventh International Symposium on Human Chlamydial Infections . Cambridge, England: Cambridge University Press; 1990;:575-579.
10 +
National Disease and Therapeutic Index (IMS America, Ltd), as quoted in: Division of STD/HIV Prevention. Sexually Transmitted Diseases Surveillance, 1993 . US Dept of Health and Human Services, Public Health Service. Atlanta, Ga:Centers for Disease Control and Prevention; 1994;.
11 +
Chernesky MA, Lee H, Schachter J, et al.  Diagnosis of Chlamydia trachomatis urethral infection in symptomatic and asymptomatic men by testing first-void urine in a ligase chain reaction assay. J Infect Dis . 1994;;170:1308-1311.
12 +
Shafer M-A, Schachter J, Moncada J, et al.  Evaluation of urine-based screening strategies to detect Chlamydia trachomatis among sexually active asymptomatic young males . JAMA . 1993;;270:2065-2070.
13 +
Gunn RA, Spitters CE.  Screening for Chlamydia trachomatis: a case for empirical treatment. JAMA . 1994;;271:1741-1742.
14 +
Genç M, Ruusuvaara L, Mårdh P-A.  An economic evaluation of screening for Chlamydia trachomatis in adolescent males. JAMA . 1993;;270:2057-2064.
15 +
Genç M, Domeika M, Mårdh P-A.  Cost-effectiveness of screening for Chlamydia using DNA amplification. JAMA . 1994;;271:1741.
16 +
Martin DH, Mroczkowski TF, Dalu ZA, et al.  A controlled trial of a single dose of azithromycin for the treatment of chlamydial urethritis and cervicitis. N Engl J Med . 1992;;327:921-925.
17 +
Lauharanta J, Saarinen K, Mustonen MT, Happonen HP.  Single-dose oral azithromycin versus seven-day doxycycline in the treatment of non-gonococcal urethritis in males. J Antimicrob Chemother . June 1993;;( (suppl E) ):177-183.
18 +
Lister PJ, Balechandran T, Ridgway GL, Robinson AJ.  Comparison of azithromycin and doxycycline in the treatment of non-gonococcal urethritis in men. J Antimicrob Chemother . June 1993;;( (suppl E) ):185-192.
19 +
Drug Topics Red Book . Montrose, NJ: Medical Economics Co; 1995;.
20 +
Sclar DA, Tartaglione TA, Fine MJ.  Overview of issues related to medical compliance with implications for the outpatient management of infectious diseases. Infect Agents Dis . 1994;;3( (5) ):266-273.
21 +
Katz BP, Zwickl BW, Caine VA, Jones RB.  Compliance with antibiotic therapy for Chlamydia trachomatis and Neisseria gonorrhoeae. Sex Transm Dis . 1992;;19: 351-354.
22 +
Haddix A, Hillis S, Kassler W.  The cost-effectiveness of azithromycin for Chlamydia trachomatis infections in women. Sex Transm Dis . In press.
23 +
Wong ES, Hooton TM, Hill CC, McKevitt M, Stamm WE.  Clinical and microbiological features of persistent or recurrent nongonococcal urethritis in men. J Infect Dis . 1988;;158:1098-1101.
24 +
Jones RB, Van Der Pol B, Martin DH, Shepard MK.  Partial characterization of Chlamydia trachomatis isolates resistant to multiple antibiotics. J Infect Dis . 1990;; 162:1309-1315.
25 +
Hooton TM, Wong ES, Barnes RC, et al.  Erythromycin for persistent or recurrent nongonococcal urethritis. Ann Intern Med . 1990;;113:21-26.

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