Non-gonococcal urethritis

What is urethritis?

Urethritis is the most common condition in men attending sexual health clinics (GUM clinics) in the UK. Inflammation of the urethra usually causes symptoms in men, such as discharge, soreness of the penis and pain passing urine.

In women, it usually causes no symptoms, but if untreated can go on to cause serious conditions such as pelvic inflammatory disease (PID). It is usually caused by to a sexually transmitted infection (STI), but has several possible causes.

• Gonococcal urethritis is caused by a germ (bacterium) called Neisseria gonorrhoeae. Gonorrhoea is one type of STI. See the separate leaflet called Gonorrhoea.

• Non-gonococcal urethritis (NGU) is due to causes other than gonorrhoea. This used to be called nonspecific urethritis (NSU). This leaflet is just about NGU and describes it further.

• It is possible to have both gonococcal and non-gonococcal urethritis at the same time.

See also the separate leaflet called Urethritis and Urethral Discharge in Men, which includes a diagram explaining the male anatomy in this area.

What are the symptoms of non-gonococcal urethritis?

• A white fluid (discharge) from the end of the penis is common but does not occur in every case.

• Burning or pain when urinating. This may be confused with a urine infection.

• Soreness, irritation or itch inside the penis.

• A feeling of wanting to pass urine frequently.

• In a small number of cases the infection travels up the tube between the bladder and the end of the penis (the urethra) to the testicles (testes) and causes pain and swelling in one or both testicles. See the separate leaflet called Epididymo-orchitis.

• A rare complication is a type of arthritis which can be triggered by NGU. It may be due to the immune system over-reacting to some germs (bacteria) that can cause NGU.

• Up to a quarter of men with urethritis do not have any symptoms.

• In women, NGU usually causes no symptoms, but it may spread up the reproductive organs to cause pelvic inflammatory disease, which may cause severe illness and may also affect fertility. See the separate leaflet called Pelvic Inflammatory Disease. Symptoms can include pelvic or lower abdominal pain, fever, altered periods, altered vaginal discharge, pain during sexual intercourse and pain passing urine.

The symptoms may clear over time, even without treatment. This may take up to six months but can be just a couple of weeks or so. However, without treatment, bacteria that cause NGU often remain in the urethra. It is just that the symptoms may go.

What causes non-gonococcal urethritis?

Infection with chlamydia

This causes about half of cases of NGU. Chlamydia is a germ (bacterium) that is usually caught by sexual contact with an infected person. You can pass chlamydia on during vaginal, anal or oral sex. See the separate leaflet called Chlamydia.

Various other bacteria or viruses

Other bacteria or viruses, most of which are sexually transmitted, can cause NGU. (For example, herpes simplex, trichomonas, Mycoplasma genitalium and those germs which cause urinary tract infections.)

A non-infective problem

This is, rarely, the cause. For example:

• Injury from a thin, flexible tube (a catheter).

• Surgery to the tube between the bladder and the end of the penis (the urethra).

• A narrowing (stenosis) of the urethra.

• Stones in the urethra.

• Conditions affecting the lining of the urethra - for example, irritation from soaps, lotions or spermicide cream.

No cause

No cause can be found in about half of all cases. STIs that are not identified by tests are probably the cause of some of these but not all. However, it is not possible to say which of these cases are due to infection and which are not.

Who develops urethritis?

Anyone can develop urethritis, but it is more common in sexually active men under 25 with a recent change in sexual partner. Not using condoms increases your risk of urethritis, as does having any STI.

Is non-gonococcal urethritis contagious?

Usually, NGU is contagious. If the cause is an infection, such as chlamydia or other sexually transmitted infection, it is usually highly contagious.

This is why it is very important to attend a sexual health (GUM) clinic for testing and treatment if you suspect you may have it, and not have sex until you have the all clear from the clinic. Non-infective causes are not contagious, but the vast majority of cases are infective.

Do I need tests?

Yes - you will normally be advised to have tests if NGU is suspected, even if symptoms go. If you suspect that you have NGU or any other STI then ideally you should attend your GP or local genitourinary medicine (GUM) clinic - you can find your nearest clinic by following the link in the Further Reading section below.

You will probably be asked to provide a urine specimen to try to identify the cause of the infection. You will also have a tiny sample (swab) taken from the tube called the urethra (between the bladder and the end of thepenis) in men, and often a vaginal swab is taken in women.

You will usually also be advised to have tests for other STIs, including for HIV and syphilis. This may involve having blood tests. Men who have sex with men may also be advised to have a swab from the back of the throat (pharynx) and back passage (rectum).

What is the treatment for non-gonococcal urethritis?

A course of medicines called antibiotics is usually used as the treatment for NGU. The antibiotic prescribed may depend on which germs (bacteria) are likely to be found (often chlamydia) and whether other infections are also present.

One antibiotic is usually given as a large single dose, although sometimes a four-day course is needed - azithromycin. The other is taken twice-daily for seven days - doxycycline. There are other antibiotic regimes which may be used in your area.

If no bacteria are found in the test results, you may still be advised to take a course of antibiotics if you have symptoms of NGU. Infection is still the likely cause, even if a bacterium cannot be identified.

Most people get better with antibiotic treatment. It is important to finish the course.

Does my sexual partner need treatment?

Yes. Any person you have had sex with in the previous four weeks should be tested for infection, even if they do not have any symptoms. A course of medicines called antibiotics is usually advised for sexual partners, even if the tests are negative, because:

• Many women who are infected with chlamydia do not have symptoms. If this is left untreated, it can cause complications at a later time, such as a serious infection of the womb (uterus) and tubes, called pelvic inflammatory disease, and infertility.

• Germs (bacteria) that cause NGU are often passed on during sex. Some of these bacteria may cause pelvic inflammatory disease (PID) in women. Tests for bacteria are not foolproof. A course of antibiotics helps to make sure that any possible infection is cleared.

• If your sexual partner is infected and not treated, the infection can be passed back to you.

If you have NGU without any symptoms then you may have had it for some time. In this situation, any sexual partners within the previous six months should be tested and treated.

Follow-up

A doctor or healthcare professional will often want to know that treatment has worked. It is common to be reviewed a couple of weeks after you start treatment, to check that symptoms have gone and the infection has cleared. Sometimes re-testing and a second antibiotic medicine are needed if symptoms persist.

Can non-gonococcal urethritis be prevented?

Wearing a condom during sex (including anal and oral sex) helps to prevent the spread of STIs. The risk of STIs increases with the number of changes of sexual partner. So, the fewer sexual partners you have, the lower your risk of STIs.