WS 238-2003 Diagnostic criteria and management principles for non-gonococcal urethritis
Some standard content:
Chapter 2 of this standard is mandatory, and the rest are recommended. WS238--2003
Non-gonococcal urethritis is a common sexually transmitted disease, mainly caused by Chlamydia trachomatis and Ureaplasma urealyticum. The disease has been widespread in recent years and has a trend of substantial growth. In order to reliably diagnose and reasonably treat patients with non-gonococcal urethritis, as well as to understand the prevalence and trend of non-gonococcal urethritis in China and provide a reliable basis for prevention and control work, this standard is specially formulated. In the process of formulating this standard, the "Provisional Diagnostic Criteria and Treatment Program for Sexually Transmitted Diseases" and "Diagnostic Criteria and Treatment Principles for Sexually Transmitted Diseases" formulated by the Ministry of Health of my country were carefully studied, and the relevant parts of the Diagnostic Criteria for Non-gonococcal Urethritis revised by the Centers for Disease Control in 1996, the "Guidelines for the Treatment of Sexually Transmitted Diseases" of the Centers for Disease Control in 1998, and the "Canadian Guidelines for Sexually Transmitted Diseases" of the Canadian Centers for Disease Control and Prevention in 1998 were referred to.
Appendix A of this standard is a normative appendix, and Appendix B is an informative appendix. This standard is proposed by the Department of Disease Control of the Ministry of Health. The drafting unit of this standard is the Institute of Dermatology, Chinese Academy of Medical Sciences. The main drafter of this standard is Wang Qianqiu.
This standard is entrusted by the Ministry of Health to the Office of Supervision and Administration of Communicable Disease Prevention and Control of the Ministry of Health for interpretation. 1 Scope
Diagnostic criteria and
Treatment principles of non-gonococcal urethritis
This standard specifies the diagnostic criteria and treatment principles of non-gonococcal urethritis (cervicitis). This standard is applicable to medical and health care institutions, health and epidemic prevention institutions and STD prevention and control institutions at all levels across the country. 2 Diagnostic criteria
2.1 History of contact
There is a history of non-marital sexual contact or a history of infection of the spouse. 2.2 Clinical manifestations
2.2.1 Incubation period: almost 1 week to 3 weeks. 2.2.2 Clinical manifestations of male patients
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2.2.2.1 Urethral discharge is serous or serous-purulent, thin, and small in quantity. In a few cases, urethral discharge may be purulent, large in quantity, or even bloody.
2.2.2.2 Painful urination, or frequent urination, urethral itching and discomfort. Sometimes local pain in the penis. 2.2.3 Clinical manifestations of female patients
2.2, 3.1 Urethral discharge is serous or serous-purulent, painful urination, frequent urination. 2.2, 3.2 Increased leucorrhea, yellow or bloody, or with a peculiar smell. Bleeding during non-menstrual period or after sexual intercourse. 2.2.3.3 Mucopurulent discharge can be seen at the cervical opening, the cervix is congested, edematous, and brittle, and it is easy to bleed when touched. Sometimes a more characteristic hypertrophic follicular appearance can be seen.
2.3 Laboratory examination
2.3.1 Take urethral secretion or scraping specimens from males, or endocervical specimens from females, for smear Gram staining and gonococcal culture examination, and no evidence of gonococci
2.3.2 Smear examination
2.3.2.1 For male patients, take urethral secretion smears and do Gram staining examination. Polymorphonuclear leukocytes can be seen. Under the oil immersion lens (100×10 times), an average of ≥5 per field of view is positive. After centrifugation of the first urine (15 mL of the first urine) after 4 hours of urination, the sediment is positive under the high-power microscope (40×10 times). If an average of ≥15 polymorphonuclear leukocytes per field of view is positive. 2.3.2.2 For female patients, use a ureter to take a specimen of the endocervical canal, smear it, and do Gram staining. Under an oil immersion lens (100×10 times), if the number of polymorphonuclear leukocytes per field of view is ≥10, it is considered positive (but Trichomonas infection should be excluded). 2.3.3 Chlamydia trachomatis detection: There are cell culture method, direct immunofluorescence method, immunoassay and antigen rapid detection method. If the test result is positive, it is of diagnostic significance for non-gonococcal urethritis. 2.3.4 Ureaplasma urealyticum detection: Positive culture of Ureaplasma urealyticum in male patients, combined with medical history and other laboratory tests, is helpful for the diagnosis of non-gonococcal urethritis. bzxZ.net
2.4 Clinical diagnosis
Cases that meet the conditions of 2, 1, 2.2, 2.3.1 and 2.3.2. 2.5 Confirmed cases
Cases that meet the conditions of 2.1, 2.2, 2.3.1, 2.3.2 and 2.3.3 or 2.3.4. WS 238—2003
3 Principles of treatment
3.1 The principle of timely, adequate and regular medication should be followed, and the corresponding treatment plan should be adopted according to different conditions (see Appendix B). 3.2 Avoid sexual intercourse during treatment. Sexual partners should be treated at the same time. Follow-up should be conducted after treatment. 4 Clinical cure criteria
4.1 The subjective symptoms disappear, male patients have no urethral secretions and urinary pain, female patients have no abnormal leucorrhea symptoms, and cervical and urethral inflammation subsides.
4.2 Male patients have no white blood cells in urine sediment.
5 Management and prevention
5.1 Strengthen the publicity and education of STD prevention and control to reduce transmission and spread. 5.2 Strengthen the notification of sexual partners. All sexual contacts with patients in the month before the onset of the disease should be treated regardless of whether they have symptoms or not. 5.3 Emphasize screening in the core population and case finding among outpatients to detect and treat infected persons. 5.4 Correct use of condoms can play a preventive role. 5.5 Strengthen the management of patients. Before the disease is completely cured, sexual intercourse should be avoided; pay attention to personal hygiene, and strictly separate the use of towels, washbasins, bathtubs, sheets and other media that can cause indirect transmission; pollutants can be boiled and disinfected. 2
A.1 Collection of specimens
Appendix A
(Normative Appendix)
Laboratory diagnosis of non-gonococcal urethritis
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The pathogens that cause non-gonococcal urethritis are mainly Chlamydia trachomatis, and a few are Ureaplasma urealyticum. The most important principle for collecting specimens is to obtain specimens containing a sufficient number of pathogens. The specimens collected must contain epithelial cells. A.1.1 Urethra specimens
For male patients, the swab should be inserted 2 cm to 4 cm deep into the urethra and rotated slightly to obtain as much cell material as possible. For female patients, collecting cervical and urethral specimens at the same time can increase the detection rate of chlamydia. The method of collecting female urethral specimens is to first use your fingers to gently massage from below the pubic bone along the direction of the female urethra to observe whether there is any secretion at the urethral opening. Insert the urethral swab 1 cm to 2 cm into the urethral opening, rotate it gently and then remove it.
A.1.2 Cervical specimens
When taking cervical specimens, you should first use a swab to clean the cervical opening, and then use another swab to insert it into the cervical canal 1 cm to 1.5 cm and gently press and rotate it to obtain cell specimens. You can also use a cell brush to collect specimens. After the specimen is collected, it can be directly tested for smear examination, or placed in the corresponding transport fluid for examination according to the requirements of different laboratory examination items. A.1.3 Urine specimens
It is best to collect the first urine in the morning or urine after 2h~4h of abstinence. When collecting urine, a sterile container should be used, and 10mL~15mL of the first urine should be sent for examination. If the test is within 24h, it should be placed at 4℃, otherwise it should be frozen at -20℃ or -70℃. A.2 Specimen smear examination
Apply the swab evenly and gently on a clean glass slide, then dry it in the air, quickly pass it through a flame 2~3 times to fix it, perform Gram staining, and examine it under a microscope.
When using urine specimens for smear examination, first centrifuge the urine (2000r/min, 10min), discard the supernatant, and use the sediment for smearing. A.2.1 Gram staining
A.2.1.! Cover the fixed film with crystal violet solution and stain for 1 min. Quickly wash it in running water. A.2.1.2 Spread the smear with iodine solution and stain for 1 minute. Rinse with running water. A.2.1.3 Decolorize with acetone-ethanol solution until the smear is free of purple, usually 10s to 20s. The decolorization time depends on the thickness of the film. Avoid excessive decolorization.
A.2.1.4 Quickly rinse in running water to stop decolorization, and absorb excess water with absorbent paper. A.2.1.5 Restain with safranin or alkaline fuchsin solution for 1 minute. A.2.1.6 Rinse with running water and absorb with absorbent paper. A.2.1.7 Microscopic examination
Use a 10×100x oil microscope for examination. In the specimen smear of patients with urethral secretions (male) or cervical mucopurulent secretions (female), more red polymorphonuclear leukocytes are often seen. Pay attention to the presence of intracellular Gram-negative diplococci. In non-gonococcal urethritis, only polymorphonuclear leukocytes are seen, but no intracellular Gram-negative diplococci. The number of polymorphonuclear leukocytes is counted under the field of view of 10×40 times (urine sediment smear) or 10×100 times (swab specimen smear). A.2.1.8 Precautions
When collecting specimens, the swab should be inserted into the urethra or cervical canal, and it is not advisable to only dip the secretions outside the urethral or cervical orifice. A.3. Cell culture of Chlamydia trachomatis
Under ideal conditions, the specimen should be inoculated into the cultured cells immediately after it is obtained, because Chlamydia does not survive long in vitro. If the specimen can be sent to the laboratory within 18 hours, it can be kept at 4°C. If the delay is longer (more than 24 hours), the specimen should be frozen in ice or a refrigerator at -70°C until it is thawed before use. If the specimen is only frozen at -20°C, 90% of Chlamydia will die. Urine, semen, specimens from patients who have used antibiotics, and specimens from patients who have recently used certain vaginal preparations (douches, contraceptive creams, and uterine diaphragm creams, etc.) are not suitable for Chlamydia culture. Some specimens containing spermicides (such as phenoxyethanol-9 cream) are also not suitable for use because they are toxic to Chlamydia.
A.3.1 Materials
A.3.1.1 Cell growth medium, each 1000mL contains RPMI164016.4g, newborn calf serum 10%, gentamicin 10μg/mL, vancomycin 25μg/mL, nystatin 25U/mL, HEPES 0.01mol/L, L-glutamine 0.002mol/L, and the pH is adjusted to 7.2 with sodium bicarbonate.
A.3.1.2 Specimen transport medium, each 1000ml cell growth medium is supplemented with 3.5g glucose. A.3.1.3 Separation medium, cell growth medium is supplemented with cycloheximide, the final concentration is 1μg/mL. A.3.1.4 PBS without calcium and magnesium, add 8.0g sodium chloride (NaCl), 0.2g potassium chloride (KCl), 1.15g sodium hydrogen phosphate (NazHPO), and 0.2g potassium dihydrogen phosphate (KHPO) to every 1000mL double distilled water. A.3.1.5 Trypsin-EDTA solution, add 0.1g trypsin and 0.04g EDTA·Naa to every 200mL PBS without calcium and magnesium. A.3.1.6 Iodine staining solution, add 5.0g potassium iodide (KI), 5.0g crystal iodine, and 50mL methanol to every 50mL distilled water. A.3.1.7 Iodine glycerol sealing solution, mix equal amounts of iodine staining solution and glycerol. A.3.2 Methods
A.3.2.1 Preparation of McCoy cell monolayer
Take out McCoy cells from liquid nitrogen and quickly thaw them in a 37℃ water bath. Add it to a culture bottle containing cell growth medium, and replace it with fresh growth medium after 8 hours of cell attachment. Continue to culture at 36℃ for 2 days or 3 days until the cells fuse into a monolayer. Aspirate the culture medium and wash the monolayer with a small amount of trypsin solution. Add trypsin-EDTA solution to digest the monolayer and incubate at room temperature for 2 minutes to 3 minutes to allow the cells to completely disperse. Add growth medium and blow the cells to suspend them. Count the cells with a hemocytometer and dilute them with culture medium to reach the required concentration (if you need to generate a monolayer of cells in a 96-well plate after 48 hours, the McCoy cell concentration should be 1X105). Then inoculate it into the wells of a 96-well microplate and add 0.2mL of cell suspension to each well. A round cover glass with a diameter of 0.5cm has been placed in the well of the microplate in advance, and the cells grow on this glass slide. Cultivate for 48 hours under 5% carbon dioxide (CO2), 36°C and humid air. When the cells have grown into a monolayer under an inverted microscope, they can be used for specimen inoculation. A.3.2.2 Inoculation of clinical specimens
Take out the urethra or cervix specimen from -70°C, shake it in a 37°C water bath, and melt it quickly. Oscillate on a vortex shaker for 30 seconds, remove the swab under sterile conditions and discard it. Take out the 96-well plate cell monolayer that has grown for 48 hours, aspirate the culture medium in the well, and add 0.1mL of specimen solution. Generally, 2 wells are inoculated for each specimen (one well is used to observe the results, and the other well is used for blind transfer). Positive and negative controls are set for each batch of clinical specimens. Centrifuge the inoculated microplate at 35°C and 3000×g for 1 hour. After centrifugation, remove the inoculated specimen liquid, add 0.2mL of separation medium containing actinomycin to each well, and culture for 48 hours under 5% carbon dioxide (CO2), 36℃ and humid air conditions, and then observe the results.
A.3.2.3 Observation of results
When using the iodine staining method, the method is as follows: a) remove the separation medium in the microplate well; b) add 0.2mL of methanol to the culture well and fix for 10 minutes; c) discard the methanol, add 0.2mL of iodine staining solution, stain for 15 minutes and then discard the staining solution; d) add 1 drop of iodine glycerol sealing solution to a clean slide; e) remove the cover glass from the well, place the cell side down on the sealing solution, and observe under a microscope (10×40 times). Chlamydia inclusion bodies are located in the cytoplasm and are stained dark brown. If present, it is a positive culture for Chlamydia trachomatis. If not, scrape the cells on the glass slide in the other well, make a blind pass, and continue to inoculate on a new cell monolayer as before. Observe the results after culture. If there is still no inclusion body, it is determined to be negative, and if there is inclusion body, it is determined to be positive. When the iodine staining shows that the inclusion body morphology is atypical or the result cannot be determined, 95% ethanol 4
can be used for decolorization for 2min~3min, and then re-identified after staining with fluorescent labeled monoclonal antibody. WS238—2003
The method of Giemsa staining is basically the same as iodine staining, except that after methanol fixation, 0.2mL Giemsa staining solution is added and stained for 30min. The staining solution is aspirated, the slide is washed with phosphate buffer, and the cover glass is removed. After natural drying, it is examined under a microscope. Chlamydia inclusion bodies can also be directly stained with immunofluorescence for identification. The advantage of this method is that it can be identified at an early time (36h~48h) after culture, and it is very sensitive and specific. The disadvantage is that a fluorescence microscope is required and it is expensive. The operation steps of this method are as follows;
Use a pipette to remove the culture medium in the culture well and add 0.2 mL of methanol. Fix the cells for 10 minutes and then remove the methanol; a)
b) Add 0.1 mL of fluorescently labeled monoclonal antibody and incubate at 36°C for 30 minutes; c)
Remove the monoclonal antibody, take out the round cover glass, and rinse it with deionized water for 30 minutes; d) Use filter paper to absorb the water, place the round cover glass with the cell side facing down, and stick it on the slide with the mounting solution provided in the kit;
e) Place the slide under a fluorescence microscope for observation (10×40 times). A.3.2.4 Results
Both iodine staining and Giemsa staining can be examined with an optical microscope. However, when Giemsa staining is examined with a dark field microscope, the chlamydial inclusion body is lemon yellow and has fluorescence compared to the surrounding dark background, which is easy for beginners to identify. After iodine staining, the inclusion bodies are stained dark brown and located in the cytoplasm because they are rich in glycogen. Immunofluorescence staining shows apple green fluorescent inclusion bodies in positive cases. A,3.2.5 Precautions
A.3.2.5.1 The concentration of McCoy cells should be appropriate, and the cell monolayer density should not be too dense or too sparse, otherwise it will affect the growth of chlamydia. The appropriate cell inoculation concentration should be explored in advance. A.3.2.5.2 False negative results may occur when cells are too old, contaminated, or damaged by toxic effects. At this time, fresh, uncontaminated cells need to be replaced, and sometimes other detection methods need to be used. A.3.2.5.3 The source, batch number, dosage and preparation method of various reagents used to prepare the culture medium should be kept to trace the source of the problem. After preparing the culture medium, it should first be checked for its support for the growth of cells and known positive chlamydia strains, and whether there is any contamination, and then it can be officially used for the detection of clinical specimens.
A.3.2.5.4 Fetal bovine serum is a key component in the culture medium and should meet quality requirements. Each batch of serum should be tested in advance to see if it is suitable for the growth of Chlamydia.
A.3.2.5.5 The concentration of cycloheximide also has a great influence on the growth of Chlamydia. It should be explored in advance and different dilutions of cycloheximide should be added to the culture medium to determine the most appropriate working concentration. A.4 Direct immunofluorescence method for Chlamydia trachomatis
Currently, there is a commercial direct immunofluorescence detection kit for Chlamydia trachomatis. The kit contains mouse monoclonal antibodies against Chlamydia, positive control photos and negative control photos.
A.4.1 Method
A.4.1.1 Apply the specimen on a glass slide. Dry in air and fix with 0.5mL of acetone. A.4.1.2 Add 30μL of antibody reagent to the specimen slide and the positive and negative control photos and spread evenly. A.4.1.3 Place in a humidified box and incubate at room temperature for 15 min. Rinse with distilled water and dry in air. A.4.1.4 Add 1-2 drops of sealing solution, cover with a cover glass and observe under a fluorescence microscope (10×100 times). A.4.2 Results
Protoplasma can be seen in positive specimens. They are single, pinpoint-sized particles that emit moderate to high-intensity apple green fluorescence. For urogenital specimens, if there are 10 protoplasmas per slide, the result is positive. In a few cases, chlamydial particles that are 2 to 3 times larger than protoplasma can be seen in the slide. These may be immature chlamydia, reticulate bodies, or intermediate types between protoplasma and reticulate bodies. A.4.3 Notes
Observation of results requires a certain amount of experience. It should be noted that sometimes "artificial illusions" will appear, that is, some granular substances (leukocytes, epithelial cells, pigment granules), bacteria and yeast will emit non-specific fluorescence, and some immunoglobulins attached to the surface of bacteria can also bind to fluorescent antibodies to produce fluorescence. However, their morphology and size are different from protoplasma, and the fluorescence is yellow-green instead of apple green, and the staining is uneven, while the fluorescent staining on the surface of protoplasma is uniform and consistent. To ensure the accuracy of the test results, the observer should be trained in advance, carefully identify the morphology of various components under the microscope, and accumulate experience. In addition, high-quality fluorescence microscopes and reagents are also necessary conditions to ensure the reliability of the test. A.5 Chlamydia trachomatis enzyme-linked immunosorbent assay There is a commercial Chlamydia trachomatis enzyme-linked immunosorbent assay kit. The Chlamydia trachomatis monoclonal antibody is coated on the microplate wells to capture the Chlamydia trachomatis antigen in the specimen, and the result is determined by enzyme-linked colorimetric reaction. A.5.1 Method
A.5.1.1 Specimen collection
The specimen collection method is basically the same as described above. After collection, place it in the test tube provided by the kit and test it immediately. If batch testing is required, it can be refrigerated at 2℃~8℃ for 7 days. If it needs to be stored for a longer time, the specimen should be stored at -70℃. A.5.1.2 Specimen processing
The specimens and negative and positive controls should be placed at room temperature after being taken out. Add 1mL of treatment solution A, place at room temperature for 10min, shake for 30s, add 100μL of treatment solution B, shake for 10s. The treated specimens can be stored at 2℃~~8℃ for 24h, and should be placed in a 70℃ refrigerator for more than 24h. Before testing, all stored specimens must be shaken at room temperature for 30S. A.5.1.3 Testing
A.5.1.3.1 Take out the microplate coated with chlamydia monoclonal antibodies from the refrigerator and preheat to room temperature. For each test, set well A as the substrate blank control, wells C, D, and E as negative controls, and the remaining wells as test specimens. A.5.1.3.2 Take out 100uL of the control and clinical specimens into the wells, cover them, and incubate at room temperature for 1h. A.5.1.3.3 Add 50μL of rabbit anti-chlamydia polyclonal antibodies to each well (except well A) and incubate at room temperature for 1h. A.5.1.3.4. Add 50μL horseradish peroxidase-labeled anti-rabbit antibody to each well (except A) and incubate at room temperature for 1 hour. A.5.1.3.5 Rinse each well 5 times with flushing solution. A.5.1.3.6 Add 100μL substrate working solution to each well, cover, and incubate at room temperature for 30 minutes away from light. A.5.1.3.7 Add 100μL stop solution to each well and read the results with an ELISA reader within 1 hour (measurement wavelength 492nm, reference wavelength 620nm): A.5.2 Results
Specimens with A value ≥ value are positive. The threshold is the average value of the negative control A value plus the constant 0.1. The positive control A value must be ≥0.800, the negative control A value must be <0.080, and the substrate blank control A value must be ≤0.035 for the test to be considered valid. A.6 Rapid antigen detection of Chlamydia trachomatis
The operation steps of the rapid antigen detection method vary with different kits. The basic method is as follows. A.6.1 Place the specimen in a plastic tube containing 0.6 mL of antigen extract and place it in an 80°C water bath for 10 minutes to release the antigen. A.6.2 Squeeze the swab along the tube wall and discard it. A.6.3 Add 5 drops of extract to the sample well of the test plate and observe the results after 15 minutes. A.6.4 A thin line is seen in the result well for positive specimens, and no thin line is seen in negative specimens. In addition, whether the specimen is positive or negative, a thin line should be shown in the quality control well, indicating that the reagent quality is qualified and the test steps are correct. A.7 Ureaplasma urealyticum culture
Ureaplasma urealyticum has urease, which can decompose urea to produce ammonia, causing the pH value of the liquid culture medium containing phenol red indicator to rise and the color to change from yellow to red. At this time, it can be preliminarily judged that the Ureaplasma urealyticum culture is positive. For further confirmation, the liquid culture needs to be transferred to a solid culture medium, which can grow into characteristic fried egg-like colonies. 6
A.7.1 Materials
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A.7.1.1 Liquid culture medium: 80mL of mycoplasma basal (broth) culture medium, 10mL of horse serum or calf serum, 10mL of yeast extract, 0.5mL~1.5mL of 10% urea solution, 0.5mL of 0.4% phenol red solution, 500U/mL~2000U/mL of penicillin, adjust the pH value to 5.5~6.5 with 1mol/L hydrochloric acid, divide into small test tubes and place in the refrigerator for later use, 1.5mL~~2.0mL per tube. A.7.1.2 Solid culture medium: Add 1.2g~1.4g of agar to 100mL of mycoplasma broth culture medium, sterilize by high pressure, cool to about 50℃, and add the above additives one by one. Shake well, pour into sterile blood, wait for coagulation, and place in the refrigerator for later use. A.7.2 Methods
A.7.2.1 After the swab is taken, place it in a small tube containing culture medium, stir it several times, lift it up and squeeze it against the tube wall, and discard it. A.7.2.2 The culture medium is cultured in a 37℃ incubator and observed every day. The most suitable culture conditions are an environment containing 5% to 10% carbon dioxide (CO2) and a humidity of 60% to 80%.
A.7.2.3 After 16h to 24h of culture, if the color of the culture medium changes, transfer it to a solid culture medium. The method is to inoculate 0.1mL of culture medium on an agar plate with a diameter of 60mm, gently rotate it or use a sterile L-shaped glass to evenly distribute the bacterial liquid. A.7.2.4 Place the solid culture medium in the culture environment as described above, and after 3d to 5d of incubation, observe the morphology of the colonies of Mycoplasma adenolyticum under a low-power microscope.
A.7.3 Results
If the liquid culture medium changes color from yellow to red and becomes transparent without turbidity, it can be preliminarily judged that mycoplasma is growing. In most cases, a positive result can be obtained for Mycoplasma natans within 24 hours. If the culture medium changes color but the liquid is turbid, contamination by foreign bacteria should be ruled out. It can be filtered with a filter membrane with a pore size of 0.45μm and then inoculated into the liquid culture medium for observation. On solid culture medium, the colonies of Mycoplasma natans are very small, only 15μm~～50μm, with a coarse granular core with extremely narrow edges, sometimes like fried eggs. Negative results need to be observed for 5d~7d. If stained with the Dienes method, the colonies are a specific blue. The colonies of general bacteria are not colored and are easy to identify.
A.7.4 Precautions
A. 7.4.1 The specimen should be inoculated as soon as possible after collection, and the swab should not be allowed to dry. A.7.4.2 If inoculation is not possible temporarily, the specimen should be placed in 1 mL of transport medium (or the basic culture medium of the culture medium) and stored at low temperature. A.7.4.3 When observing the results of liquid culture medium culture, special attention should be paid to whether the culture medium is turbid. If turbid, the culture should be filtered and re-inoculated for observation.
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B.1 Principles of treatment and treatment
Appendix B
(Informative Appendix)
Treatment plan for non-gonococcal urethritis
B.1.1 Timely and effective treatment can cure patients, shorten the course of the disease, prevent complications and sequelae, and prevent transmission to others. B.1.2 Broad-spectrum antimicrobial drugs that are effective against both Chlamydia trachomatis and Mycoplasma adenolyticum should be used for treatment. The dosage should be appropriate and the course of treatment should be sufficient. B.2 Treatment plan
B.2.1 Initial non-gonococcal urethritis
B.2.1.1 Recommended plan
B.2.1.1.1 Doxycycline 100 mg, orally, twice a day, for 7 to 10 days; or B.2.1.1.2 Azithromycin 1 g, taken all at once, should be taken 1 hour before or 2 hours after meals. B.2.1.2 Alternative drugs
B.2.1.2.1 Ofloxacin 300 mg, orally, twice a day, for 7 days; or B.2.1.2.2 Minocycline 100 mg, orally, twice a day, for 7 days to 10 days; or B.2.1.2.3 Erythromycin 500 mg, orally, 4 times a day, for 7 days to 10 days; or B.2.1.2.4 Tetracycline 500 mg, orally, 4 times a day, for 7 days to 10 days. B.2.2 Recurrent or persistent non-gonococcal urethritis B.2.2.1 There is no effective treatment plan, the recommended plan is B.2.2.1.1 Metronidazole 0.4 g, twice a day, for 5 days, plus erythromycin 500 mg, orally, 4 times a day, for 14 days; or B.2.2.1.2. Erythromycin ethylsuccinate 800mg, orally, 4 times a day for a total of 7 days. B.2.3 Non-gonococcal urethritis (cervicitis) in pregnant women B.2.3.1 Erythromycin 500 mg, orally, 4 times a day, for 7 days; or erythromycin 250 mg, orally, 4 times a day, for 14 days; or B.2. 3.2
B.2.3.3 Erythromycin ethylsuccinate 800 mg, orally, 4 times a day for 7 days; or azithromycin 1 g, once.
B. 2. 3. 4
B.2.3.5 Doxycycline and ofloxacin are prohibited. B.3 Precautions
B.3.1 Chlamydia trachomatis has not yet developed clinically significant resistance to commonly used antibiotics, and there are occasional reports of tetracycline-resistant Chlamydia trachomatis strains. The number of strains of Mycoplasma that are resistant to tetracycline has reached 5% to 10% in some areas. If tetracyclines are ineffective, macrolides can be used instead.
B.3.2 In addition to the above drugs, macrolide drugs roxithromycin, clarithromycin, josamycin, fluoroquinolones such as levofloxacin, sparfloxacin and Floxacin and others have certain efficacy, but more clinical application experience needs to be accumulated. 8
Art Exam Literature
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[7] Wang Qianqiu. Diagnosis and treatment of persistent and recurrent nongonococcal urethritis. See: Editor-in-Chief Ye Qianyun. Diagnosis, Treatment and Prevention of Sexually Transmitted Diseases. Guangzhou: Guangdong Science and Technology Press, 1996: 286-289[8 ] Centers for Disease Control and Prevention. Case definitions for infectious conditions underpublic health surveillance.MMWR, 1997,26(NoRR-10):1-20[9] Centers for Disease Control and Prevention. 1998 Guideline for treatment of sexually transmitted diseases. MMWR, 1998,27(NoRR-1):1-80[io] Laboratory Center for Disease Control. Canadian STD Guideline. Heaith Canada, Ottawa,1998:1-239
[1lJ Flemming DT, Wasserheit JN. From epidemiological synergy to public health policy and practice: the contribution of other sexually transmitted diseases to the sexual transmission of HiV infection. Sex Transm Inf, 1999, 75:3-17E12J Holmes KK, Sparling PF, Mardh PA, et al. Sexually transmitted diseases . 3rd ed. NewYork:MeGraw-Hill. 1999.
[13J Hobbs M, Kazembe AW. Trichomonas vaginalis as a cause of urethritis in Malawian men.Sex Transm Dis,1999,26:381-387[14J Van Dyck E, Meheus ZA Piot P. Laboratory diagnosis of sexually transmitted diseases.Geneva: World Health Organization 1999:1-300[15J Morse SA, Moreland AA, Holmes KK. Atlas of sexually transmitted diseases and AIDSLondom: Mosby-Wolfe.1996: 1-454[16] Taylor-Robinson D. Infections due to species of mycoplasma and ureaplasma: an update. ClinInf Dis, 1996, 23:671-684E17] Taylor-Robinson D. Genital mycoplasmas. Curr Opin Infect Dis, 1995, 8 :16-21[18] World Health Organization. STD Care management, Regional Office for the Western Pacific,Malina, 1997:1-222广州：广东科技出版社，1996：286-289[8] Centers for Disease Control and Prevention. Case definitions for infectious conditions underpublic health surveillance.MMWR，1997,26(NoRR-10):1-20[9] Centers for Disease Control and Prevention. 1998 Guideline for treatment of sexually transmitted diseases.MMWR，1998,27(NoRR-1):1-80[io] Laboratory Center for Disease Control. Canadian STD Guideline. Heaith Canada, Ottawa,1998:1-239
[1lJ Flemming DT, Wasserheit JN. From epidemiological synergy to public health policy andpractice: the contribution of other sexually transmitted diseases to the sexual transmission of HiV infection. Sex Transm Inf, 1999, 75:3-17E12J Holmes KK, Sparling PF, Mardh P-A, et al. Sexually transmitted diseases. 3rd ed. NewYork:MeGraw-Hill. 1999.
[13J Hobbs M, Kazembe AW. Trichomonas vaginalis as a cause of urethritis in Malawian men.Sex Transm Dis,1999,26:381-387[14J Van Dyck E, Meheus ZA Piot P. Laboratory diagnosis of sexually transmitted diseases.Geneva: World Health Organization 1999:1-300[15J Morse SA, Moreland AA, Holmes KK. Atlas of sexually transmitted diseases and AIDSLondom:Mosby-Wolfe.1996:1-454[16] Taylor-Robinson D. Infections due to species of mycoplasma and ureaplasma: an update.ClinInf Dis，1996,23:671-684E17] Taylor-Robinson D. Genital mycoplasmas. Curr Opin Infect Dis, 1995, 8:16-21[18] World Health Organization. STD Care management, Regional Office for the Western Pacific,Malina, 1997:1-222广州：广东科技出版社，1996：286-289[8] Centers for Disease Control and Prevention. Case definitions for infectious conditions underpublic health surveillance.MMWR，1997,26(NoRR-10):1-20[9] Centers for Disease Control and Prevention. 1998 Guideline for treatment of sexually transmitted diseases.MMWR，1998,27(NoRR-1):1-80[io] Laboratory Center for Disease Control. Canadian STD Guideline. Heaith Canada, Ottawa,1998:1-239
[1lJ Flemming DT, Wasserheit JN. From epidemiological synergy to public health policy andpractice: the contribution of other sexually transmitted diseases to the sexual transmission of HiV infection. Sex Transm Inf, 1999, 75:3-17E12J Holmes KK, Sparling PF, Mardh P-A, et al. Sexually transmitted diseases. 3rd ed. NewYork:MeGraw-Hill. 1999.
[13J Hobbs M, Kazembe AW. Trichomonas vaginalis as a cause of urethritis in Malawian men.Sex Transm Dis,1999,26:381-387[14J Van Dyck E, Meheus ZA Piot P. Laboratory diagnosis of sexually transmitted diseases.Geneva: World Health Organization 1999:1-300[15J Morse SA, Moreland AA, Holmes KK. Atlas of sexually transmitted diseases and AIDSLondom:Mosby-Wolfe.1996:1-454[16] Taylor-Robinson D. Infections due to species of mycoplasma and ureaplasma: an update.ClinInf Dis，1996,23:671-684E17] Taylor-Robinson D. Genital mycoplasmas. Curr Opin Infect Dis, 1995, 8:16-21[18] World Health Organization. STD Care management, Regional Office for the Western Pacific,Malina, 1997:1-222
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