47. NON-CHLAMYDIAL NON-GONOCOCCAL URETHRITIS - MANAGEMENT AND FOLLOWUP DILEMMAS

Abstract

Aim: To audit the management of non chlamydial non gonococcal urethritis (NCNGU) for 2006.

Method: A clinic database search for cases of non-specific urethritis was conducted. Charts were reviewed and cases subsequently diagnosed with Chlamydia or gonorrhoea at the visit were excluded. One person reviewed the charts for diagnosis, microscopy, treatment, contact tracing and follow up.

Results: There were 38 recorded of cases of NCNGU. The mean age of cases was 28.8 years (SD 10.8), all were male,15.8% identified as MSM.

Microscopy was performed in 60.5% of cases and PMNLs were detected in 36.8% of all cases (63.6% of cases where microscopy was performed).

Treatment was with azithromycin in 63.2% of cases, doxycycline in 28.9% of cases, tinidazole in one case (2.6%) and no treatment was given in one case.

Patients with PMNLs on microscopy were significantly more likely to be treated with azithromycin than those without PMNLs on microscopy or with no microscopy done (93.8% vs 50.0%, p < 0.01, x² test).

Contact tracing (CT) was recommended in 17 cases (55.3%) with confirmation of partner treated in 7 cases. There was no significant difference in contact tracing recommendation between those with PMNLs on microscopy and those without or microscopy not done (56.3% vs 36.4%, p > 0.2, x² test).

Clinical follow up at the clinic occurred in 25 cases. 80% (95%CI 60.9%-91.1%) of those followed up had resolution of symptoms, with the remainder having a recurrence or failure of resolution.

Discussion: NSU management should include antibiotic cover for possible undetected Chlamydia. Azithromycin was more likely to be used if PMNLs were detected. Chlamydia treatment occurred in all but two cases, with one of the two cases having had adequate treatment previously.

New Australian CT guidelines recommend CT M. genitalium but not for NSU. We would recommend CT current or most recent partners in all cases of NCNGU.