Overview

Urethritis is inflammation of the urethra, the tube that carries urine from the bladder out of the body. It's usually caused by an infection.

The term non-gonococcal urethritis (NGU) is used when the condition isn't caused by the sexually transmitted infection gonorrhoea.

NGU is sometimes referred to as non-specific urethritis (NSU) when no cause can be found.

Urethritis is the most common condition diagnosed and treated among men in GUM clinics or sexual health clinics in the UK.

This topic covers:

Symptoms of non-gonococcal urethritis

Symptoms of NGU in men include:

  • a white or cloudy discharge from the tip of the penis
  • a burning or painful sensation when you pee
  • the tip of your penis feeling irritated and sore

In women, NGU rarely causes any symptoms.

Read about the symptoms of NGU.

When to seek medical advice

Visit your local genitourinary medicine (GUM) clinic or sexual health clinic if you're experiencing symptoms of NGU or you may have been exposed to a sexually transmitted infection (STI).

You should still seek treatment if the symptoms of NGU disappear on their own, as there's a risk you could pass the infection on to someone else.

Find sexual health services.

Diagnosing non-gonococcal urethritis

Two tests can be used to diagnose NGU, and both may be carried out to ensure the diagnosis is correct.

The tests are:

  • a swab test – a sample of fluid is taken from your urethra using a swab, which is like a small cotton bud with a plastic loop at the end; it's not painful, but can feel a little uncomfortable for a few seconds
  • a urine test – you'll be asked not to urinate for at least one hour before providing a urine sample as this can help make the test results more reliable

You may also be offered tests for other STIs. It's up to you whether to have these or not, but a test for all infections is recommended. You can discuss this with healthcare professionals at the clinic if you wish.

Some clinics will be able to give you the results on the same day. Others may need to send the samples to a laboratory for testing, in which case the test results may not be available for a week or two.

Healthcare professionals at the clinic will tell you when you'll get your test results, and they'll also arrange your treatment.

Read more about visiting a sexual health clinic.

Causes of non-gonococcal urethritis

NGU can have a number of possible causes, including:

There are many cases of NGU where no infection is found. If no cause is found, you'll still be offered treatment for possible infection.

Read more about the causes of NGU.

Treating non-gonococcal urethritis

A short course of antibiotics is usually prescribed to treat NGU. You may be given them before you get your test results, and symptoms should clear up after about two weeks.

It's important that past and current sexual partners are also treated to prevent any infection spreading to others.

You should avoid having sex, including anal and oral sex, until you have finished your course of antibiotics.

Your symptoms should improve within a week.

You may be asked to attend a follow-up appointment to check if your treatment has been successful. If this is the case it is important to attend even if you do not have any symptoms.

After treatment has been completed and the symptoms have disappeared, it should be safe to start having sex again.

Read more about treating NGU.

Preventing non-gonococcal urethritis

As NGU is usually caused by an STI, practising safer sex is the best way to reduce the chances of it developing.

Safer sex involves using barrier contraception, such as condoms, and having regular checks at sexual health clinics or GUMs.

Read a guide to contraception.

Complications of non-gonococcal urethritis

NGU can have some complications – for example, the condition can keep coming back.

You should return to the genitourinary medicine (GUM) clinic or sexual health clinic if you still have symptoms two weeks after starting a course of antibiotics.

Serious complications are rare, but may include:

Women often have no symptoms of NGU. However, it can lead to pelvic inflammatory disease (PID) if it's caused by chlamydia and left untreated.

Repeated episodes of PID are associated with an increased risk of infertility.

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Symptoms

Non-gonococcal urethritis (NGU) can cause different symptoms in men and women. In some cases, NGU doesn't cause any symptoms at all.

Symptoms of NGU in men

The symptoms of NGU in men can include:

  • a white or cloudy discharge from the tip of the penis
  • a burning or painful sensation when you pee
  • the tip of your penis feeling irritated and sore

Depending on the cause of NGU, symptoms may begin a few weeks or several months after an infection.

If NGU has a non-infectious cause, such as irritation to the urethra, symptoms may begin after a couple of days.

Symptoms that start a day or two after sex are not usually caused by an STI, but testing for STIs is still recommended.

Read about the causes of NGU.

Symptoms of NGU in women

NGU is a condition in men that tends to cause no noticeable symptoms in women.

However, the infections that cause NGU in men can spread to other parts of the female reproductive system – for example, the womb or fallopian tubes, which connect the ovaries to the womb.

If the infection does spread, a woman may develop pelvic inflammatory disease (PID).

PID is a serious health condition that can cause persistent pain. Repeated episodes of PID are associated with an increased risk of infertility.

Some women with PID don't have symptoms. If there are symptoms, they include:

  • pain around the pelvis or lower part of your stomach (abdomen)
  • discomfort or pain during sexual intercourse that is felt deep inside the pelvis
  • bleeding between periods and after sex
  • pain when you urinate
  • heavy or painful periods
  • unusual vaginal discharge – especially if it is yellow or green

A few women with PID become very ill with:

  • severe lower abdominal pain
  • a fever (high temperature) of 38C (100.4F) or above
  • nausea and vomiting
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Who can get it

Non-gonococcal urethritis (NGU) can have a number of possible causes, such as an infection, irritation or damage to the urethra.

There are also many cases where no cause is found – this is sometimes known as non-specific urethritis (NSU).

Sexually transmitted infections (STIs)

If urethritis is caused by gonorrhoea, it is known as gonococcal urethritis.

NGU can also be caused by other sexually transmitted infections (STIs), such as chlamydia. Chlamydia is spread during unprotected sex (sex without a condom), including anal and oral sex.

Urethritis is more common among people who are at risk of STIs. This includes people who:

  • are sexually active
  • have had unprotected sex
  • have recently had a new sexual partner

Other infections

A number of other infections can cause NGU. These are caused by other bacteria that usually live harmlessly in the throat, mouth or rectum.

These bacteria can cause NGU if they get into the urethra, which is the tube that carries urine from the bladder to the outside of the body. This can occur during oral or anal sex.

Infections that can cause NGU include:

  • Trichomonas vaginalis – an STI caused by a tiny parasite
  • Mycoplasma genitalium – tests for this condition have only recently been developed and are not available in all clinics yet; if you can't be tested, you will be treated as though you might have it
  • urinary tract infection
  • the herpes simplex virus – this can also cause cold sores and genital herpes
  • an adenovirus – usually causes a sore throat or an eye infection

Non-infectious causes

It's possible for NGU to have a non-infectious cause. This is when something else leads to the urethra becoming inflamed.

Non-infectious causes of NGU include:

  • irritation from a product used in the genital area – such as soap, deodorant or spermicide
  • damage to the urethra caused by vigorous sex or masturbation, or by frequently squeezing the urethra – some men may do this if they're worried they have an infection
  • damage to the urethra caused by inserting an object into it, such as a catheter – this can be done during an operation in hospital
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Treatment

Non-gonococcal urethritis (NGU) is usually treated with a short course of antibiotics to kill the bacteria that caused the infection.

The healthcare professionals at the genitourinary medicine (GUM) clinic or sexual health clinic will arrange your treatment.

If your urethritis is caused by gonorrhoea, this may be treated differently.

Antibiotics

Treatment with antibiotics may be started before you receive your test results. Most people with NGU are prescribed antibiotic tablets or capsules.

This may be:

  • azithromycin – taken just once as a single dose
  • doxycycline – taken twice a day for seven days

You won't usually need to return to the clinic as long as you've:

  • taken your treatment
  • made sure that any recent partners have been treated
  • not had any sex until a week after everyone has been treated

It may sometimes take two or three weeks for your symptoms to disappear completely.

You shouldn't have sex, including vaginal, anal and oral sex, until:

  • you've finished your course of doxycycline, or it's been seven days since you took azithromycin
  • you have no symptoms
  • your partner or partners have also been treated

Side effects

Antibiotics may cause some side effects, such as:

Informing partners

It's possible to pass on NGU during sex, so it's wise to treat all cases of NGU as an STI and ensure all recent partners have been treated.

You also shouldn't have any kind of sex until you're certain the condition has cleared up.

It's suggested that you inform any person you've had sex with in the last three months, but this timeframe can vary. The healthcare professionals at the GUM clinic can advise you.

Some people can feel angry, upset or embarrassed about discussing STIs with their current partner or previous partners.

However, don't be afraid to discuss your concerns with the healthcare professionals at the GUM or sexual health clinic. They can advise you about who to contact and the best way to contact them.

With your permission, the clinic can arrange for a "contact slip" to be given to your former partner or partners.

The slip explains that they may have been exposed to an STI and advises them to have a check-up. It doesn't have your name on it, and your details will remain totally confidential.

Nobody can force you to tell any of your partners about your STI, but it's strongly recommended that you do. Without treatment, STIs such as chlamydia can have serious effects on a person's health, particularly for women.

Complications of untreated chlamydia include:

Treatment failure

If the symptoms of non-gonococcal urethritis (NGU) don't get better two weeks after you start to take antibiotics, you should return to the GUM clinic or sexual health clinic.

You'll be asked if you took the medication correctly and whether anyone with untreated NGU could have passed the infection back to you.

You may need further tests to confirm your diagnosis and check for any sexually transmitted infections (STIs).

In some cases, you may be given a new prescription for some different antibiotics to treat the NGU.

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The information on this page has been adapted by NHS Wales from original content supplied by NHS UK NHS website nhs.uk
Last Updated: 22/09/2020 11:49:36