The Enigma of Non-Gonococcal Urethritis: Role for Bacteroides Ureolyticus

Abstract

SUMMARY Although up to about halfthe cases ofacute non-gonococcal urethritis (NGU) are caused by Chlamydia trachomatis organisms (chlamydiae) and a smaller, ill-defined, proportion probably by Ureaplasma urealyticum organisms (ureaplasmas), the aetiology of all cases is not understood. Clarification of the role of the anaerobe, Bacteroides ureolyticus, was sought in the current study. Seventy five chlamydia negative patients with NGU were treated on a double blind placebo controlled basis with metronidazole. After seven days more of the 35 patients given this drug tended to improve clinically than the 40 given the placebo, but the difference was not significant. Of 23 chlamydia negative but anaerobe positive men, however, 78% (7/9) receiving metronidazole responded clinically, but only 7% (1/14) receiving placebo responded (p<0 001). Furthermore, whereas 78% of the anaerobe positive men given metronidazole recovered, only 23% (6/26) of the anaerobe negative men did so (p < 0.02). No further evidence for the role of ureaplasmas in the aetiology ofNGU was obtained, but the data suggest that B ureolyticus organisms, and perhaps other anaerobes, have an important role in a small proportion of cases and that the beneficial effects of metronidazole given on an empirical basis will be confined to anaerobe positive urethritis.Evidence that Chlamydia trachomatis organisms (chlamydiae) are a cause of non-gonococcal urethritis (NGU) is overwhelming.' Chlamydial infection, however, is probably responsible for no more than about half the cases. Ureaplasma urealyticum organisms (ureaplasmas) In a study of the anaerobic microbial flora of the urethra, we found a Gram negative anaerobic bacillus appreciably more often in patients with NGU than in those withoit, and termed it a "NGU-associated anaerobe".5 Subsequent work showed that this

The possible role of anaerobic bacteria in chronic prostatitis

“…B. ureolyticus is, considered to be part of the normal¯ora in both the male and female genital tract, has also been isolated from mixed cultures of infections of virtually every organ system in man (Duerden et al, 1982). It has previously been found to be associated with male nongonococcal urethritis, where it was suggested that this organism may have a pathogenic role (Hawkins et al, 1988;Balmelli et al, 1994). Eley et al (1995) studied the pathogenicity of B. ureolyticus in animals and established that a pure culture of B. ureolyticus is capable of producing infection when it is injected subcutaneously into mice.…”

The possible role of anaerobic bacteria in chronic prostatitis

“…B. ureolyticus is, considered to be part of the normal flora in both the male and female genital tract, has also been isolated from mixed cultures of infections of virtually every organ system in man (Duerden et al ., 1982). It has previously been found to be associated with male non‐gonococcal urethritis, where it was suggested that this organism may have a pathogenic role (Hawkins et al ., 1988; Balmelli et al ., 1994). Eley et al .…”

An association between non-gonococcal urethritis and bacterial vaginosis and the implications for patients and their sexual partners.

“…In addition, only six (23%) of 26 anaerobe negative men responded to metronidazole therapy. 18 However, other workers have isolated B ureolyticus as frequently from men with NGU as from those without NGU and contend that this organism is merely a part of the normal urethral flora. '9 G vaginalis has been isolated from the urethra of 11.4% of male GUM attendees and more often from heterosexual than homosexual individuals.20 Its presence, however, was not associated with symptoms of urethritis, although microscopic evidence of inflammation was not sought.…”