NON-SPECIFIC URETHRITIS:
Dear Sumner:
Harry, a 43 year old married man, is sure he has contracted a venereal disease. He told me he woke up to find some sticky, mucous-like material on his pajamas and experiences slight discomfort while urinating. The discharge from his penis has become more marked each time he checks to see if it is still present. On further questioning he admitted to having had a recent sexual contact with an old friend about one week previously. We are probably dealing with non-specific urethritis, but I will order the standard venereal disease tests. While waiting for you to see him, I will start him on tetracycline. But given the extent of his distress, both he and I would feel much more comfortable if you would advise any further evaluation or therapy.
Dear Scott:
As you know non-specific urethritis (NSU), also referred to as Non-gonococcal-urethritis, is usually caused by chlamydia or mycoplasma organism. Occasionally the symptoms are caused by an inflammatory process without an offending organism. While waiting for the results of the culture (which, in the case of chlamydia, may take a week or so for the final word, you very wisely started him on tetracycline. The fact that the cultures came back negative means either that the offending organism was not picked up on the culture ort that there was no infection present. The symptoms could have been caused by a reaction to a local irritant such as soap, vaginal creams or spermicides used by his partner, or even from excessive irritation from sexual activity. As you stated in your letter, Harry has been squeezing his penis fairly often to see if the discharge is still present. In the process, it is possible that these maneuvers themselves are perpetuating the inflammatory process causing the persistent urethral discharge By the time that Harry arrived in my office I received the results of cultures and blood studies. As you probably know, both urethral discharge and urine cultures were negative for mycoplasma and chlamydia organisms. If Harry was having repeated sex with this woman, and if chlamydia were the culprit, consideration would be given to giving her a course of the tetracycline (or some other appropriate medication, realizing the potential of causing a Vaginitis in the process of trying to eradicate the chlamydia). Rechecking Harry’s urethral washings (1st part of the urine) would be advisable after a few weeks would be appropriate. Also it would be wise if Harry used his penis only for urinating for a couple of weeks.
