Study regarding the etiology of non-gonococcal/non-chlamydial urogenital bacterial infections

Abstract

Major urogenital infections are those caused by Neisseria gonorrhoeae and Chlamydia trachomatis, with the potential for ascending urethral and primary endocervical involvement. At the same time, in 2/3 of cases, urogenital infections are caused by other germs, including bacteria, protozoa, yeasts, and viruses. These often have a chronic and recurrent course, with primary urethral and vaginal localization, significantly diminishing patients’ quality of life. Syndromic treatment of these infections is not sufficient in many cases. Establishing the etiology of non-gonococcal/non-chlamydial urogenital infections and instituting appropriate treatment can be a challenge in medical practice. Researchers aim was to study the etiological spectrum of non-gonococcal and non-chlamydial bacterial infections in urethritis/vaginal discharge with the aim of optimizing their management. Material and methods The study was conducted on 2132 patients seen at Anenii-Noi District Hospital between 2019 and 2023, with 944 cases examined by a dermatovenereologist and 1188 cases by an obstetrician-gynecologist. The laboratory method applied was culture on blood agar or gelatin-blood medium. Results Out of 2132 examined individuals, 1228 (57.6%) had signs of urethral and/or vaginal discharge. The spectrum of bacterial infections detected in patients with clinical signs was as follows: Staphylococcus aureus - 214 (17.4%); Staphylococcus haemolyticus - 226 (18.4%); Streptococcus pyogenes - 11 (0.9%); other Streptococcus spp. - 64 (5.2%); Enterococcus - 306 (24.9%); Escherichia coli - 210 (17.1%); Klebsiella spp. - 112 (9.1%); Proteus spp. - 78 (6.4%); other bacteria - 7 (0.6%). The presence of dual infections was established in approximately 40% of cases. Discussion Non-gonococcal/non-chlamydial bacterial infections, occasionally referred to as nonspecific urinary tract infections, are considered a common cause of urethritis/prostatitis and vulvovaginitis. The actual etiology of urethritis and vaginitis remains difficult to establish nowadays, as a significant portion of patients self-medicate for urethral and vaginal discharges or are treated syndromally by family doctors or nurses. The failure of these treatments and the persistence of clinical signs direct patients to specialized medical services capable of establishing the etiology of inflammatory urogenital conditions. The study showed the dominant proportion of enterococcal infections at 42%, including those with Escherichia, closely followed by staphylococcal infections at 35.8%. The study also established a proportion of approximately 40% for bacterial polymicrobialism detected in non-gonococcal/non-chlamydial urogenital bacterial infections.