Non-gonococcal urethritis

1 - ACKNOWLEDGEMENTS

The text below has been provided by IUSTI (International Union against Sexually Transmitted Infections). This text was written with the help of the IUSTI, the EADV (European Association of Dermatology and Venereology) and its task force on Sexually Tansmitted Infections, the ISIDOG (International Society for Infectious Diseases in Obstetrics and Gynecology) and the UEMS-EBDV (European Union of Medical Specialists - European Board of Dermatovenereology).

The update is from 2017.

You can download the pdf here.

2 - KEY POINTS

Non-gonococcal urethritis (NGU) is usually a sexually transmitted infection.

There are many different causes. Some, but not all, are passed on through having sex, and in some men a cause is never found (identified).

You can protect yourself by ALWAYS using condoms when you have sex. 

3 - WHAT IS NGU? 

— Urethritis is inflammation of the urethra (tube where urine comes out).

— It is called non-gonococcal urethritis (NGU) when the cause is not known and the sexual infection gonorrhoea (which can cause inflammation) has been ruled out.

— There are many different causes. Some, but not all, are passed on through having sex. If you have NGU there may be more than one cause, and in some men a cause is never found.

— The commonest infections causing NGU are Chlamydia and Mycoplasma genitalium in 20 to 70% of cases. Other infections that can cause NGU include Trichomonas vaginalis, U. urealyticum, Adenoviruses or Herpes simplex viruses types 1 and 2. Bacteria that cause infection in the urinary tract (kidneys, bladder and urethra) can lead to inflammation of the urethra. A vaginal infection in your partner, such as thrush or bacterial vaginosis, may trigger NGU in you.

— In some cases of NGU, no infection is found on tests and the cause is unclear. It is very likely that some cases of NGU are not due to an infection, but at the moment we do not have the tests to tell us which these are. 

4 - HOW DO YOU GET NGU? 

— You can catch NGU when you have sex with someone who already has the infection. This can be by vaginal sex, oral sex or anal sex. 

— Not all cases of non-specific urethritis are caused by having sex. 

— Even if you have had NGU before, you can still catch it again.

5 - WHAT ARE THE SYMPTOMS OF NGU?  

— The most common symptoms in men are 

•  Burning when passing urine 

• Discharge from the end of the penis 

•  Irritation / itch at the tip of the penis 

• There may be pain or discomfort in the testicles 

— Some men have no symptoms.

6 - DO I NEED ANY TESTS? 

— If you think you have been in contact with a sexually transmitted infection, or have symptoms that could be NGU you should visit your family doctor or local sexual health or venereology/dermatology clinic. 

— A sample from the tip of the penis is needed to make the diagnosis. This is collected using a swab a bit like a cotton bud, but is smaller and rounded. It sometimes has a small plastic loop on the end rather than a cotton tip. It only takes a few seconds and is not usually painful, though it may be uncomfortable for a moment. In some clinics they can look at the sample under the microscope straightaway and tell you if there are signs of inflammation. 

— The accuracy of looking for signs of inflammation under the microscope depends on the skill of the person doing the test and how long since you last passed urine. Most men are advised not to urinate for at least two hours beforehand so that the test is as accurate as possible.

— If you have signs and symptoms but the test doesn’t confirm non-specific urethritis, you may be asked not to pass urine overnight and come back to be tested again. 

— As well as testing for signs of inflammation it is recommended that you also have a test for chlamydia, mycoplasma and gonorrhoea at the same time. This is usually done on a urine sample. 

— If you have NGU, you should also be tested for other sexually transmitted infections such as HIV, syphilis, and hepatitis B, as you can have more than one infection at the same time.

7 - WHAT IS THE TREATMENT FOR NGU? 

NGU is treated with antibiotic tablets, usually doxycycline or azithromycin. Both antibiotics need to be taken for several days.

8 - SHOULD I HAVE SEX IF I HAVE NGU? 

You should either avoid sex completely or use condoms every time you have sex, until aboth you and your partner(s) have finished all your treatment and your symptoms have gone.

9 - WHAT ARE THE POSSIBLE COMPLICATIONS OF NGU? 

If left untreated, some causes of NGU can have long-term consequences, although these are uncommon. They can include: 

• Pain and swelling in the testicles.
• In rare cases, NGU may cause other symptoms such as arthritis (swollen joints) and inflammation of the eyes. This is known as reactive arthritis.
• NGU caused by chlamydia can lead to pelvic inflammatory disease (PID) in your female partner. This can cause abdominal and pelvic pain. It can also lead to infertility and ectopic pregnancy (a pregnancy that occurs outside the womb).

10 - DO I NEED TO TELL MY PARTNER? 

— If you do have NGU, it is important that your current sexual partner, and any other sexual partner you have had over the last four weeks, is tested and treated. 

— This is to stop you getting the infection again, and prevent complications in your partner(s).

11 - FURTHER HELP AND INFORMATION

If you suspect that you have NGU or any other sexually transmitted infection, then see your family doctor or local sexual health or venereology/dermatology clinic.