Nongonococcal urethritis: New views through the prism of modern molecular microbiology


The rapidly advancing technology of modern molecular microbiology has greatly improved our understanding of the epidemiology of sexually transmitted infections and the etiology and pathogenesis of the diseases they cause. It is now clear that Mycoplasma genitalium accounts for a significant proportion of nonchlamydial nongonococcal urethritis (NGU) cases. DNA sequencing of Ureaplasma spp has revealed a new species, Ureaplasma parvum. This organism may account for much of the colonization observed in asymptomatic men, which confounded many past studies of the role of Ureaplasma spp in NGU. At long last, we can say that Ureaplasma urealyticum is a true pathogen. The use of polymerase chain reaction technology has shown that Trichomonas vaginalis occurs more frequently in men with NGU than had been thought; however, such studies also have demonstrated that it is more prevalent in asymptomatic men. Finally, recent studies have shown that adenovirus should be added to the list of viral causes of NGU.

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References and Recommended Reading

  1. 1.

    Robertson JA, Stemke GW, Davis JW Jr, et al.: Proposal of Ureaplasma parvum sp. nov. and emended description of Ureaplasma urealyticum (Shepard et al. 1974) Robertson et al. 2001. Int J Syst Evol Microbiol 2002, 52:587–597.

    PubMed  Google Scholar 

  2. 2.

    Martin DH: Urethritis in males. In Sexually Transmitted Diseases. 4th ed. Edited by Holmes KK, Sparling PF, Stamm W, et al. New York: McGraw-Hill; 2007.

    Google Scholar 

  3. 3.

    Deguchi T, Yoshida T, Miyazawa T, et al.: Association of Ureaplasma urealyticum (biovar 2) with nongonococcal urethritis. Sex Transm Dis 2004, 31:192–195.

    PubMed  Article  Google Scholar 

  4. 4.

    Povlsen K, Bjornelius E, Lidbrink P, et al.: Relationship of Ureaplasma urealyticum biovar 2 to nongonococcal urethritis. Eur J Clin Microbiol Infect Dis 2002, 21:97–101.

    PubMed  Article  CAS  Google Scholar 

  5. 5.

    Yoshida T, Deguchi T, Meda S, et al.: Quantitative detection of Ureaplasma parvum (biovar 1) and Ureaplasma urealyticum (biovar 2) in urine specimens from men with and without urethritis by real-time polymerase chain reaction. Sex Transm Dis 2007, 34:416–419.

    PubMed  Article  Google Scholar 

  6. 6.

    Yoshida T, Ishiko H, Yasuda M, et al.: Polymerase chain reaction-based subtyping of ureaplasma parvum and ureaplasma urealyticum in first-pass urine samples from men with or without urethritis. Sex Transm Dis 2005, 32:454–457.

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Tully JG, Taylor-Robinson D, Cole RM, et al.: A newly discovered mycoplasma in the human urogenital tract. Lancet 1981, 1:1288–1291.

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    Jensen JS: Mycoplasma genitalium: the aetiological agent of urethritis and other sexually transmitted diseases. J Eur Acad Dermatol Venereol 2004, 18:1–11.

    PubMed  Article  Google Scholar 

  9. 9.

    Yokoi S, Maeda S, Kubota Y, et al.: The role of Mycoplasma genitalium and Ureaplasma urealyticum biovar 2 in postgonococcal urethritis. Clin Infect Dis 2007, 45:866–871.

    PubMed  Article  Google Scholar 

  10. 10.

    Mena L, Wang X, Mroczkowski TF, et al.: Mycoplasma genitalium infections in asymptomatic men and men with urethritis attending a sexually transmitted diseases clinic in New Orleans. Clin Infect Dis 2002, 35:1167–1173.

    PubMed  Article  Google Scholar 

  11. 11.

    Totten PA, Schwartz MA, Sjostrom KE, et al.: Association of Mycoplasma genitalium with nongonococcal urethritis in heterosexual men. J Infect Dis 2001, 183:269–276.

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    Morency P, Dubois MJ, Gresenguet G, et al.: Aetiology of urethral discharge in Bangui, Central African Republic. Sex Transm Infect 2001, 77:125–129.

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    Hjorth SV, Bjornelius E, Lidbrink P, et al.: Sequence-based typing of Mycoplasma genitalium reveals sexual transmission. J Clin Microbiol 2006, 44:2078–2083.

    PubMed  Article  Google Scholar 

  14. 14.

    Falk L, Fredlund H, Jensen JS: Tetracycline treatment does not eradicate Mycoplasma genitalium. Sex Transm Infect 2003, 79:318–319.

    PubMed  Article  CAS  Google Scholar 

  15. 15.

    Wikstrom A, Jensen JS: Mycoplasma genitalium: a common cause of persistent urethritis among men treated with doxycycline. Sex Transm Infect 2006, 82:276–279.

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Bradshaw CS, Jensen JS, Tabrizi SN, et al.: Azithromycin failure in Mycoplasma genitalium urethritis. Emerg Infect Dis 2006, 12:1149–1152.

    PubMed  CAS  Google Scholar 

  17. 17.

    Joyner JL, Douglas JM Jr, Ragsdale S, et al.: Comparative prevalence of infection with Trichomonas vaginalis among men attending a sexually transmitted diseases clinic. Sex Transm Dis 2000, 27:236–240.

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    Schwebke JR, Hook EW 3rd: High rates of Trichomonas vaginalis among men attending a sexually transmitted diseases clinic: implications for screening and urethritis management. J Infect Dis 2003, 188:465–468.

    PubMed  Article  Google Scholar 

  19. 19.

    Wendel KA, Erbelding EJ, Gaydos CA, et al.: Use of urine polymerase chain reaction to define the prevalence and clinical presentation of Trichomonas vaginalis in men attending an STD clinic. Sex Transm Infect 2003, 79:151–153.

    PubMed  Article  CAS  Google Scholar 

  20. 20.

    US Centers for Disease Control and Prevention: Sexually Transmitted Diseases Treatment Guidelines, 2006. MMWR Morb Mortal Wkly Rep 2006, 55(RR-11):1–94.

    Google Scholar 

  21. 21.

    Bradshaw CS, Tabrizi SN, Read TR, et al.: Etiologies of nongonococcal urethritis: bacteria, viruses, and the association with orogenital exposure. J Infect Dis 2006, 193:336–345.

    PubMed  Article  Google Scholar 

  22. 22.

    Azariah S, Reid M: Adenovirus and non-gonococcal urethritis. Int J STD AIDS 2000, 11:548–550.

    PubMed  Article  CAS  Google Scholar 

  23. 23.

    Bradshaw CS, Denham IM, Fairley CK: Characteristics of adenovirus associated urethritis. Sex Transm Infect 2002, 78:445–447.

    PubMed  Article  CAS  Google Scholar 

  24. 24.

    Lautenschlager S, Eichmann A: Urethritis: an underestimated clinical variant of genital herpes in men? J Am Acad Dermatol 2002, 46:307–308.

    PubMed  Article  Google Scholar 

  25. 25.

    O’Mahony C: Adenoviral non-gonococcal urethritis. Int J STD AIDS 2006, 17:203–204.

    PubMed  Article  CAS  Google Scholar 

  26. 26.

    Urra E, Alkorta M, Sota M, et al.: Orogenital transmission of Neisseria meningitidis serogroup C confirmed by genotyping techniques. Eur J Clin Microbiol Infect Dis 2005, 24:51–53.

    PubMed  Article  CAS  Google Scholar 

  27. 27.

    Ferris MJ, Masztal A, Aldridge KE, et al.: Association of Atopobium vaginae, a recently described metronidazole resistant anaerobe, with bacterial vaginosis. BMC Infect Dis 2004, 4:5.

    PubMed  Article  Google Scholar 

  28. 28.

    Fredricks DN, Fiedler TL, Marrazzo JM: Molecular identification of bacteria associated with bacterial vaginosis. N Engl J Med 2005, 353:1899–1911.

    PubMed  Article  CAS  Google Scholar 

  29. 29.

    Keane FE, Thomas BJ, Whitaker L, et al.: An association between non-gonococcal urethritis and bacterial vaginosis and the implications for patients and their sexual partners. Genitourin Med 1997, 73:373–377.

    PubMed  CAS  Google Scholar 

  30. 30.

    Riemersma WA, van der Schee CJ, van der Meijden WI, et al.: Microbial population diversity in the urethras of healthy males and males suffering from nonchlamydial, nongonococcal urethritis. J Clin Microbiol 2003, 41:1977–1986.

    PubMed  Article  CAS  Google Scholar 

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Correspondence to David H. Martin.

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Martin, D.H. Nongonococcal urethritis: New views through the prism of modern molecular microbiology. Curr Infect Dis Rep 10, 128–132 (2008).

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  • Herpes Simplex Virus
  • Bacterial Vaginosis
  • Genital Herpes
  • Urethritis
  • Neisseria Meningitidis