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Non-gonococcal infection is a sexually transmitted infection (STI) which has many etiologic organisms such as Chlamydia trachomatis, Mycoplasma genitalium, Ureaplasma urealyticum etc. Of them, the most common one is C. trachomatis. However, M. genitalium has been increasingly reported and recent evidence shows that it can cause acute or persistent urethritis and cervicitis. Some species of Mycoplasma spp. and Ureaplasma spp. are normal commensal flora in the both male and female genital tracts. U. urealyticum has also been reported as a pathogen but more evidence is further required. M. genitalium and U. urealyticum infections are diagnosed by the swabs of the urethra, cervix, vagina, and first void urine for culture or nucleic acid amplification test (NAAT). The culture of these organisms is complicated and impractical in real-life practice. For the NAATs, only few hospitals can accommodate due to its high cost. Thailand follows the treatment guideline provided by the Centers for Disease Control and Prevention, United States which uses a combination of two antibiotics based on the antibiotic susceptibility. For the treatment of U. urealyticum infection, there is no consensus on the recommended treatment regimen. As a result, in case of non-gonococcal infection of which the specific organisms cannot be identified, antibiotics for the treatment of C. trachomatis should be initiated and follow-up should be scheduled. If the patient has persistent symptoms or other organisms are later detected, consultation or referral to a specialist is recommended for further proper management.
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