Studies in non-gonococcal urethritis therapy. The long-term value of tetracycline.

Studies in non-gonococcal urethritis therapy The long-term value of tetracycline W. FOWLER The General Hospital, Birmingham In the majority of cases of non-gonococcal urethritis the cause is unknown, but it is widely believed to be an infectious agent, or agents, transmitted during sexual intercourse.Treatment, necessarily empirical, is mainly based on this belief and usually consists of sulphonamides, sulphonamides combined with strep- tomycin, or broad spectrum antibiotics.The latter, and in particular members of the tetracycline group, are most frequently prescribed, and it is generally considered that tetracycline provides the most effective treatment (Morton and Morrison, 1963) although equally good results were earlier claimed for combined sulphonamide and streptomycin therapy (Jelinek, 1957).The natural course of non-gonococcal urethritis is obscure, and it is not easy to make an accurate assessment of the effect of treatment.Although Holmes, Johnson, and Floyd (1967), by means of a short-term cross-over trial, demonstrated conclusively that tetracycline was more effective than a placebo, the ultimate efficacy of this treatment is unknown, and reported cure rates have varied from about 14 per cent.(Fowler, 1958) to over 80 per cent.(Willcox, 1957).This is the report of a clinical trial carried out to determine, if possible, the real value of tetracycline, by comparing it with lactose and with streptomycin combined with sulphonamides.A computer was used to analyse the results of treatment and to see if any clinical or other features might be discerned which would indicate when specific therapy should be prescribed.The computer data sheets have been de- scribed previously (Fowler and Leeming, 1969).The trial was started on January 1, 1965 and ended on December 31, 1965.During this time 833 cases of non-gonococcal urethritis were registered in the clinic.Initially, 650 patients were included in the trial; these had no past history of Reiter's disease, pre- sented no obvious cause for the urethritis, had not recently suffered from gonorrhoea, and had received no treatment before admission.Subsequently, fifty cases were removed from the trial either because a cause was established, or because the condition was Received for publication April 8, 1970 not a primary urethritis, or because manifestations of Reiter's disease developed.Computer analysis of cases showed no significant differences in race, age, marital status, previous history, possible incubation period, or duration of symptoms before admission.This information is not therefore given in detail, but can be provided if re- quested.