The Cinderella Disease

NGU, the most common VD

To most people, venereal disease means either syphilis or gonorrhea. But, in fact, the most common venereal disease in America today is one that has been so overlooked by both the public and doctors that a British expert has dubbed it "the Cinderella of sexually transmissible infections." The clinical name of the Cinderella disease: nongonococcal urethritis, or NGU.

Urethritis is an inflammation of the urethra, the channel carrying urine from the bladder. In gonorrhea victims, it is caused by the gonococcus bacterium. But in a majority of cases of NGU, no gonococcus can be found--hence the name nongonococcal urethritis. Though the cause of NGU cannot always be determined, researchers have in recent years identified a culprit in about half the cases: a tiny bacterium called Chlamydia trachomatis, the same microbe that causes trachoma, an eye disease.

Chlamydial infections usually produce mild but recognizable symptoms in men: pain during urination and a clear, watery mucoid discharge. The infection is not as readily apparent in women; chlamydia can remain unnoticed in the cervix, producing no apparent symptoms. Left untreated, the infection may lead to serious complications. Men can develop inflammation of the epididymis, which carries sperm from the testis. In women, inflammation may occur in the cervix or the fallopian tubes (which can become blocked, causing sterility) and other pelvic areas. Even worse, the infection can be passed on to babies during birth, causing eye infections and pneumonia. Says Epidemiologist Julius Schachter of the University of California at San Francisco: "Five percent, at a minimum, of all newborn infants are exposed to these organisms. Forty percent to 50% of all babies passing through an infected cervix acquire chlamydial infection."

Public health experts say that NGU is increasing at an epidemic rate, far faster than gonorrhea. It is now the most common sexually transmitted disease in developed countries. Though the true incidence of NGU is unknown in the U.S., in part because physicians here are not required to report cases, the Center for Disease Control estimates that between 4 million and 9 million Americans are afflicted. NGU is noted most often in young, single, sexually active whites from the middle and upper classes. Says Dr. William McCormack of Harvard Medical School: "Almost all of the urethritis that is seen in college health services and in private practice is nongonococcal."

Despite the NGU epidemic, gonorrhea, which generally attacks the poor, blacks and other less privileged members of society, receives swifter and more comprehensive care. The reason, in part, is that the symptoms of NGU, though uncomfortable, are generally relatively mild compared with those of gonorrhea; male victims sometimes feel they can defer medical attention. Women are usually unaware that they are infected. Doctors, too, are at fault. Some still are not familiar with NGU and confuse it with gonorrhea, resulting in inappropriate treatment.

Indeed, it is sometimes difficult to distinguish between NGU and gonorrhea by physical examination alone (though gonorrhea tends to produce a yellowish discharge). Because the technique for culturing chlamydia is not yet widely available, doctors diagnose NGU by examining a smear or culture of discharge for the presence of gonococci. If none are there, the disease is NGU. Unlike gonorrhea, which usually responds to penicillin, NGU is treated with tetracycline or erythromycin.

Still, the greatest problem in halting the spread of NGU is the tendency of physicians to regard it as a urological condition in men rather than a venereal disease affecting both sexes. Consequently, because women's symptoms are not obvious and because little effort has been made to trace and treat the female sexual partners of male victims (a vital element in venereal disease control), the disease Ping Pongs through the population. But progress is being made. Says Dr. McCormack: "Five years ago, neither men nor women were being treated appropriately. Now it's mainly the women."

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