Article 146: Symptoms, Examination, and Western Medicine Treatment of Non-gonococcal Urethritis
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Treatment and recuperation of common diseases
What are the symptoms?
1. Painful urination: Discomfort, itching, stinging or burning pain in the urethra, which varies in intensity and is generally milder than that of gonorrhea.
2. Urethral discharge and urethral redness and swelling: The discharge is mostly serous or mucopurulent, thinner and less abundant than the discharge from gonococcal urethritis, and rarely flows from the urethral opening. Sometimes, after prolonged periods without urination or before the first urination in the morning, discharge may stain underwear or form a sticky substance that seals the urethral opening, with mild redness and swelling at the urethral opening. Hematuria may occur when complicated by cystitis, but some patients are asymptomatic.
Epididymitis is a major complication of non-gonococcal urethritis in men. The main symptoms are swelling and tenderness of the epididymis; if the testicle is involved, pain and tenderness may occur, along with scrotal edema and thickening of the vas deferens. In addition, it can be complicated by prostatitis, a feeling of heaviness and dull pain in the posterior urethra, perineum, and anus, and sexual dysfunction.
What tests should be done?
1. After holding urine for several hours, insert a urine swab 2-4 cm into the urethra and collect the secretions. If 10-15 neutrophils can be seen in the secretions under high power, and there are no gonococci, non-gonococcal urethritis can be suspected.
2. Immunofluorescence assay can be used to detect Chlamydia trachomatis and Ureaplasma urealyticum; a positive result is sufficient for diagnosis.
How does Western medicine treat this?
For urethritis caused by Chlamydia trachomatis and Mycoplasma, tetracyclines and macrolides are the most effective medications. When possible, etiological diagnosis should be performed on all patients to guide treatment. If testing for Chlamydia and Mycoplasma is difficult due to limited resources, broad-spectrum antibiotics can be used.
1. Tetracyclines:
(1) Tetracycline: 500 mg each time, 4 times a day for 14 days, orally. Tetracycline has shown satisfactory effects against Chlamydia trachomatis, Ureaplasma urealyticum and Mycoplasma hominis. If Chlamydia trachomatis or Mycoplasma are still isolated after 14 days of treatment, a second course of treatment can be given.
(2) Doxycycline: 200 mg each time, twice a day for 14 days, orally.
(3) Minocycline: 100 mg each time, twice a day for 14 days, with the first dose doubled.
2. Macrolides:
(1) Erythromycin: 500 mg each time, 4 times a day for 14 days, orally. It is effective against Chlamydia trachomatis and Ureaplasma urealyticum, but ineffective against Mycoplasma hominis.
(2) Josamycin: 400 mg each time, 4 times a day for a total of 14 days, orally.
3. Quinolones: such as norfloxacin, sildenafil, etc.
How does Traditional Chinese Medicine differentiate syndromes and treat diseases?
1. Damp-heat accumulation type: Symptoms include frequent and burning urination, urgency and discomfort, cloudy urine, fever and chills, bitter taste in the mouth and dry stool, red tongue with yellow and greasy coating.
Treatment principle: Clear heat, promote diuresis, and relieve strangury.
Prescription: Akebia quinata 15g, Plantago asiatica (wrapped) 15g, Polygonum aviculare 15g, Rheum palmatum 5g, Talcum 15g, Glycyrrhiza uralensis 10g, Dianthus superbus 15g, Gardenia jasminoides 15g, Juncus effusus 10g, Pyrrosia lingua 15g, Imperata cylindrica 15g.
2. Dampness and blood stasis obstruction type: Symptoms include dribbling and difficulty urinating, or foul discharge from the urinary tract, lower abdominal distension and pain, dark purple tongue with greasy coating, and wiry and slippery pulse.
Treatment principle: dispel dampness and turbidity, promote qi and blood circulation.
Prescription: Forsythia 15g, red adzuki bean 20g, angelica 10g, lindera 10g, coix seed 20g, yam 15g, septum 10g, poria cocos 15g, dioscorea hypoglauca 15g, amber powder (to be taken with water) 5g, achyranthes bidentata 10g, licorice root tip 6g.
3. Kidney Qi Deficiency Type: Symptoms include scanty, dark urine, painful urination, dribbling, persistent urination, soreness and weakness in the lower back and knees, pale tongue, and thin white coating.
Treatment principle: Regulate and nourish the liver and kidneys, nourish yin and strengthen the body.
Prescription: 20g Rehmannia glutinosa, 25g Dipsacus asper, 20g Eucommia ulmoides, 15g Lycium barbarum, 15g Achyranthes bidentata, 15g Dioscorea opposita, 15g Smilax glabra, 15g Plantago asiatica (wrapped), 15g Alisma plantago-aquatica, 20g Taxillus chinensis, 20g Pyrrosia lingua, 15g Scutellaria baicalensis, 15g Anemarrhena asphodeloides, 5g Glycyrrhiza uralensis.
4. Spleen and Kidney Deficiency Type: Symptoms include frequent urination, which worsens with exertion, or turbid discharge from the urinary tract, fatigue, poor appetite, loose stools, lower abdominal distension, soreness and weakness in the lower back and knees, pale tongue or swollen tongue with a white and greasy coating, and weak pulse.
Treatment principle: warm the kidneys and strengthen the spleen, dispel dampness and eliminate turbidity.
Prescription: 3g cinnamon, 3g aconite, 15g prepared rehmannia root, 12g cornus officinalis, 15g yam, 10g peony bark, 15g poria cocos, 10g alisma plantago-aquatica, 10g plantain seed (wrapped), 10g dioscorea hypoglauca, 15g acorus tatarinowii, 10g lindera strychnifolia, 12g alpinia oxyphylla.