Non-specific urethritis investigated by Ziehl-Neelsen staining of the urethral discharge.

The first description of abacterial urethritis is attributed to Guiard (1897) and his observation was confirmed by Barlow (1899) who also reported that contagious discharges could occur in which no organisms were detectable. Conventionally, when cases of non-gonococcal urethritis are examined by Gram-stained smears, if no organisms are seen the discharge is termed "abacterial"; if a mixture of organisms is present the disorder is frequently termed "non-specific". For over 70 years attempts to identify causative organisms in non-gonococcal urethritis have met with only partial success. Some of the investigations carried out on mycoplasmata, Haemophilus vaginalis, anaerobic organisms, viruses, and on the role of allergy have been reviewed by Morrison (1967). The organisms found in cases of non-specific urethritis may include staphylococci, streptococci, diphtheroids, coliforms, B. subtilis, and B. proteus. It is notable that Doderlein's bacillus, though normally present in the vagina from the onset of menstruation to the menopause, is almost never seen in smears of male urethral discharges. Harkness (1950) described a case of desquamative urethritis in which B. crassus was found, but he considered it a commensal; he also referred to one case described and another quoted by Brunauer (1927). In cases of non-specific urethritis there is frequently a lack of genital cleanliness, particularly in uncircumcised men, and in their sexual partners the presence of smegma around the clitoris and around the labia is as frequent. It has, therefore, seemed reasonable to consider the possible role of the smegma bacillus in non-specific urethritis. Smegma bacilli, though Gram-positive, are not easily stained by this method and are therefore unlikely to be seen during routine smear examination in cases of non-specific urethritis. In this investigation, in addition to standard procedures an acid-fast staining method has been employed.