Dimitrova, H.

Gardevska, V.

Kaprelian, G.

Karayashev, G.

Krasteva, T.

Panayotova, A.

Penev, Z.

Rusev, V.

Slavov, M.

Tomov, Sh.

Tzekova, F.

Tzonev, D.

Vankov, V.

English

Varna Medical University Press: Journals

UPON T H E ETIOLOGICAL T R E A T M E N T OF B A C T E R I A L NONGONOCOCCAL URETHRITIS Z. Penev, G. Kaprelian, T. Krasteva, H . Dimitrova, G. Karayashev, V. Rusev, Sh. Tomov, M. Slavov, V. Gardevska, D. Tzonev, A. Panayotova, F . Tzekova, V. Vankov The real distribution of the nongonococcal urethritis (NGU) is still not analyzed statistically. It is quite obvious that they multiply constantly and acquire the features of venereal pathology (2, 5, 7, 8, 9, 10, 17). The polyetio-logical beginning as well as their chronic course cause certain therapeutical problems which arouse, any way, psycho-functional disorders for the patients. Assuming the hypothesis for the resistance of the bacterial agent and the altered local ground as well as the reactivity of the urethral mucosa being an important reason for the therapeutical difficulties, we intent to apply cor-ticosteroids along with the appropriate etiological treatment. Material and methods The study covers 69 male patients, aged 20—50 years (about 75% include the age between 20—30 years). A l l patients were thoroughly investigated before the treatment — urologically, microscopically, bacteriologically, v i -rologically and serologically. The sensitivity of the isolated bacterial strains towards the most commonly used antibiotics was determined by using the diffusion method. Two models of treatment were applied: I — The patients were treated on the base of the bacteriological inve-stigations and the established (in vitro) antibiotic-sensitivity of the bacte-rial strains isolated from 28 patients of this group. The mean prolongation (duration) of the treatment was 7 days. I I — By using the first model we simultaneously apply corticosteroid (Prednisolon F) to the treatment of 15 patients. The initial dose of adminis-tration was 3 mg daily with a 3-days-period gradual decrease of the dose. The mean duration of the treatment was 10 days. The therapeutical results were studied until the 30th day after the treatment. Therapeutical effect over 20 patients was not established as a result of some side-effects and deviations from the standard treatment. Results and discussion On the grounds of the carried investigations we can make some conclu-sions concerning the etiology of NGU of the studied patients (table 1): Various bacterial strains were isolated from 36 patients of all 69 (52.2%). The rest 33 patients (47.8%) showed a mixed infection: 25 of them (36.2%) with Trychomonas vaginalis and bacteria, 6 of them (8.7%) with viruses and bacteria, and 2 of them (2.9%) with mycoplasmas and bacteria. 86 Z. Penev, G . Kaprelian, T. Krasteva, H. Dimitrova, G. Karayashev. T. vaginalis is considered as one of the most common reasons for NGU According to some authors (1 , 7, 17) 8.8—50% of all inflammatory diseases of the urethral mucosa of male patients are a result of trychomonas. Other authors (12, 16, 20) discuss the etiological role of mycoplasma for NGU. Mav T a b l e l Etiology of Nongonococcal Urethritis Etiological types Patients % Bacterial 36 52.2 Mixed: a) trichomonas vaginalis and bacteria b) viruses and bacteria c) mycoplasmas and bacteria 25 6 2 36.2 8.7 2.9 Total 69 100 rov P. P. et al. (10) establishes mycoplasma in 13.4% of healthy people and 23% of patients with postgonococcial urethritis (L-forms). Jansch H . et al. (16) considers mycoplasma Т-strains as a reason for NGU in 37% of their in­vestigations. The authors recommend that every patient is obligatory stu­died for mycoplasma. The sensitivity of the isolated strains towards the most commonly used antibiotics (in vitro), on the base of an ordinary assay, is shown on table 2. Gentamycin was most often applied — 15 patients, followed by kanamycin — 8 patients, tetraolean — 4 patients, etc. T a b l e 2 Sensitivity of Bacterial Species, Isolated from N G U Patients, Relative to Antibiotics — Rating Assay No Bacterial species No of pati­ents Penicillin Streptomycin Methicillin Erythran Chlornitro-mycin Resistomycin Oleandomycin Tetracyclin *o >» о < с 'о >> Е я о > Tetraolean о о, Е < с Е о ! Staph, epidermidis 2 Staph, albus 3 E . coli 4 St. albus n. haem. 5 Enterococcus 6 Strept. pyogenicus 7 Staph, aureus 8 Staph, albus p-haem. 9 Micr. albicans 10 B . proteus 16 9 9 8 8 6 5 4 3 1 1.4 1.2 0.2 1.5 0.6 1.5 0.4 0.5 0.3 1 1.2 1.5 0.8 1.7 0.6 0.5 0.8 1.0 2 1 2.1 0.9 0.9 2.6 0.8 1.1 1.2 2.0 2.6 1.1 0.9 0.4 0.8 1.0 1.1 0.2 1.0 1.6 0.8 1 0.9 1 1.5 1.3 1.2 0.7 1 1 1.9 0.9 1.4 1.5 1.0 0.8 0.6 1.2 2 1 1.1 0.4 0.4 0.7 1.0 0.9 0.6 1.0 2 0.7 0.9 0.1 0.7 1.0 0.8 04 0.7 1 0.2 1.6 0.3 0.1 1.7 1 0 1.1 1.2 2 2.6 0.9 0.9 0.2 1 0.8 0.6 1 1.2 1.3 1.3 1.3 0.3 1.5 2 1.6 1.8 1.2 2 2 1.6 2 1.4 1.7 1.2 1.6 1.6 2 3 2 Upon the etiological treatment of bacterial nongonococcal urethritis 87 The results of the etiological treatment of 28 patients by using the first therapeutical model (antibiotic or antibiotic simultaneously with trychomo-nacid according to the case) were the following: cured — 12 patients (80%), with clinical improvement — 3 patients (20%). The results of the first the­rapeutical model were similar to those of other authors (4, 14). According to Carrol B . et .al . (12) the etiological treatment requires a therapeutical effect in 33.3% of all patients under treatment. Lopatin A. I . (9) reports the highest percent (80%) of cured patients using neurigramon. In conclusion: the results of the treatment by using both models show the necessity of a preliminary bacteriological stydy of the patients with NGU. Besides, along with the etiological treatment of these patients, the applica­tion (administration) of corticosteroids considerably improves the therapeu­tical effect. The expedience of this model of treatment wil l be an object of future investigations. R E F E R E N C E S 1. А н т о н о в , Е., Л. Д ъ с к а р о в . Дерм, и венгр., 1969, 8, 4, 262—266. — 2. Б о-н е в , А. В кн.: Пови проблеми в дерматол. и венерол. 1969, 2, 157—169. — 3. Д ra­p e л , П. , Ж- К у т ю р и с ъ т р. В кн.: Нови проблеми в дерматол. и венерол., 1967, I , 212—214. — 4 . П о п х р и с т о в , П. Негонококови уретрити, Мед, и физк., С , 1957. — 5. П о п х р и с т о в , П. , А. Б о н е в . Негонококови уретрити. В кн.: Прак­тическа венерол., 1968, 158—177. — 6. П о п х р и с т о в , П. , И л . П е т к о в , И. Г р и г о р о в , И. Т о л е в . Негонококови уретрити, Дерм, и венер. — уч., 1971, 505—509. — 7. П о п о в , Л. Негонококови уретрити. Дерм, и венер. — у ч . , I I изд., 1963, 731. — 8. П о п о в , Л . , К р. Б а л а б а н о в , Б. Б ъ ч в а р о в . Негоноко­кови уретрити. Дерм, и венер. — у ч . , 1957, 673. — 9. Л о п а т и н , А. И. Вест. Дерматол. и венерол., 1975, 2, 71—72. — 10. М а в р о в, И. И., А. С. К в е т н а я . Вест. Дерматол. и венерол., 1975, 5, 78—81. — 11. П о л я к о в , А. И., С. М. К р и-г е р. Вест. Дерматол. и венерол., М., 1968, 11, 86—87. — 12. Carrol, В. R . Т., S. С. N i с o l. Brit. Y. vener. Dis., 1970, 46, 1, 31—33. — 13. H o r v a t h , А., J . G a l g o c z y , A . K o b a c s , J . D a r o s z у . Orv. Hetil., 1971, 112, 31, 1820— 1822. — 14. K i n g , A. Med. Clin. N. Amer., 1972, 56, 56, 5, 1193—1202. — 15. J , a n s с h, H . H . Hautarzt, 1972, 23, 12, 558. — 16. J a n s с h, H . H . , O. A . R о d е r-raund. Z. Hautkr., 1974, 49, 10, 439—443. — 17. J a n s s о n, A . , A . L a s s u s, S. S t u b b, S. T u u r i . Brit. J. ven. Dis., 1971, 47, 2, 122—125. — 18. L a s s u s, A . , R . L . P е r k o, S. S t u b b , R. H a t t i 1 a, A . J a n s о n. Brit. J. vener. Dis., 1971, 47, 2, 126—130. — 19. W r i g h t, D. J . M. Brit. J. vener. Dis . , 1969, 45, 2, 167— 169. — 20. W i l l o x , R . R. Brit. J. vener. Dis., 1968, 44, 2, 157—159. ОБ Э Т И О Л О Г И Ч Е С К О М Л Е Ч Е Н И И Б А К Т Е Р И А Л Ь Н Ы Х Н Е Г О Н О К О К К О В Ы Х У Р Е Т Р И Т О В Зл. Пенев, Г. Капрелян, Т. Крыстева, Хр. Димитрова, Г. Караяшев, В. Русев, Ш. Томов, М. Славов, В. Гырдевска, Д. Цонев, А. Панайотова, Фл. Цекова, В. Янков Р Е З Ю М Е Авторский коллектив поставил перед собой задачу подвергнуть анализу причины и благоприятствующие моменты для появления негонококковых уретритов и возмож­ности для их эффективного этиологического лечения. Д л я этой цели больные были ан­кетированы и предварительно исследованы — от каждого был сделан посев и анти-биограмма, на основании которой проводилось лечение. Наряду с этим были проведены исследования на микоплазматическую, трихомонадную, вирусную и микоплазматиче-скую инфекцию. На основе обширного материала анализированы изолированные бак­териальные штаммы и их чувствительность к применяемым в практике антибиотикам. Лечение больных было проведено по двум схемам, в соответствии с устойчивостью изо­лированного бактериального штамма, без и с включением глюкокортикостероидов. 

UPON THE ETIOLOGICAL TREATMENT OF BACTERIAL NONGONOCOCCAL URETHRITIS

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UPON THE ETIOLOGICAL TREATMENT OF BACTERIAL NONGONOCOCCAL URETHRITIS

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