Urethritis is inflammation of the urethra – the tube that carries urine from the bladder out of the body. It is usually caused by an infection.
The term non-gonococcal urethritis (NGU) is used when the condition is not caused by gonorrhoea – a sexually transmitted infection (STI).
NGU is sometimes referred to as non-specific urethritis (NSU) when no cause can be found.
If you think you have NGU, you should visit your local genitourinary medicine (GUM) clinic or sexual health clinic. These clinics have access to specialist diagnostic equipment that your GP may not have.
It is easy to find sexual health services in your area. Sexual health services are free and available to everyone, regardless of age, sex, ethnic origin and sexual orientation.
Why does NGU happen?
NGU can have a number of possible causes, including irritation to the urethra and STIs. Chlamydia causes up to 43 out of 100 cases of NGU.
There are many cases of NGU where no infection is found. If no cause is found, you will still be offered treatment for possible infection. This is also the case if inflammation is caused by an object such as a catheter in the urethra, or by using creams and soaps around the genitals.
Who is affected?
Urethritis is the most common condition diagnosed and treated among men in GUM clinics or sexual health clinics in the UK.
There are around 80,000 men diagnosed with urethritis every year. It is more difficult to diagnose urethritis in women because it may not cause as many symptoms.
NGU is usually diagnosed after urine and swab tests.
Non-gonococcal urethritis (NGU) can cause different symptoms in men and women. In some cases, NGU does not cause any symptoms at all.
Symptoms of NGU in men
- a white or cloudy discharge from the tip of the penis
- a burning or painful sensation when you urinate (pee)
- the tip of your penis feeling irritated and sore
- a frequent need to urinate
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 usually not caused by an STI, but testing for STIs is still recommended.
If a current or recent sexual partner informs you that you may have been exposed to a sexually transmitted infection (STI) that can cause NGU, but you don’t have any symptoms, don’t assume that you do not have NGU. If this happens, it is always recommended that you get tested at your local genitourinary medicine (GUM) clinic or sexual health clinic.
You should still seek treatment if the symptoms of NGU disappear on their own, as there is still a risk you could pass the infection on to someone else.
Symptoms of NGU in women
NGU tends to cause no noticeable symptoms in women unless the infection spreads to other parts of the female reproductive system, such as 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
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.
Treatment with antibiotics may be started before you receive your test results (read about diagnosing NGU for information about these tests).
If your test results do not identify an infection, or your NGU is related to inflammation caused by an object, cream or soap, antibiotics are also used frequently.
Most people with NGU are prescribed antibiotic tablets or capsules. This may be:
- azithromycin – which is taken just once as a single dose
- doxycycline – which is taken twice a day for seven days
You will usually not need to return to the clinic as long as you have:
- 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 should not have sex, including vaginal, anal and oral sex, until:
- you have finished your course of doxycycline, or it has been seven days since you took azithromycin
- you have no symptoms
- your partner or partners have also been treated
Antibiotics may cause some side effects, such as:
- feeling sick
Antibiotics used to treat NGU may interact with the combined contraceptive pill and the contraceptive patch. If you use these methods of contraception, your GP or nurse can advise you about which additional contraception is suitable.
NGU and sexually transmitted infections (STIs)
While not all cases of NGU are caused by a sexually transmitted infection (STI), it is possible to pass on NGU during sex. Therefore, you should treat all cases of NGU as an STI and ensure that all recent partners have been treated.
You also shouldn’t have any kind of sex until you are certain the condition has cleared up.
NGU does not tend to cause any noticeable symptoms in women, but can still affect a woman’s long-term health. The bacteria associated with NGU can trigger the development of pelvic inflammatory disease (PID), which is more serous.
Therefore, you should always tell your current partner and any recent sexual partners if you are diagnosed with NGU. They will also need to be tested and treated for the condition.
It is important that your current sexual partner is tested and treated.
Any sexual partners you have had since being exposed to the STI will also need to be informed, so they can be tested and treated. It is suggested that you inform any person you have 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. The slip does not 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 is strongly recommended that you do. Left untested and untreated, STIs such as chlamydia can have serious effects on a person’s health, particularly for women.
Complications of untreated chlamydia include:
- infection of the testicles in men
- infection of the cervix (neck of the womb) in women
- PID – which can increase the risk of infertility and ectopic pregnancy
If the symptoms of non-gonococcal urethritis (NGU) do not get better two weeks after you start to take antibiotics, you should return to the genitourinary medicine (GUM) clinic or sexual health clinic.
You will be asked if you took the medication correctly and whether anyone who may have NGU that has not been treated could have passed the infection back to you.
You may need further tests to confirm your diagnosis and to check for any sexually transmitted infections (STIs). Read more about diagnosing NGU.
In some cases you may be given a new prescription for some different antibiotics to treat the NGU.
As most cases of non-gonococcal urethritis (NGU) are caused by a sexually transmitted infection (STI), the best way to protect yourself is to practise safer sex. Using a condom when you have sex, including vaginal, oral and anal sex, can help prevent you getting or passing on an STI.
There are a number of steps you can take to ensure you are having safer sex, such as:
- keeping the number of sexual partners to a minimum
- using a barrier method of contraception, such as condoms, every time you have vaginal or anal sex
- covering the penis with a condom or the female genitals with a latex or plastic square (dam) if you have oral sex
- avoid sharing sex toys; if you do share them, make sure you wash or cover them with a new condom * before anyone else uses them
You and your partner(s) should have regular check-ups for STIs. If you are not in a stable relationship and are sexually active, you should have a check-up every year. You should have tests more often than this if you have unprotected sex with a new partner, or if you notice any symptoms that worry you.
Testing can be done at your GP surgery, or at a genitourinary medicine (GUM) clinic or sexual health clinic.
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Not all cases of NGU are caused by an STI. It can also be the result of irritation caused by creams, lotions and objects.
To prevent NGU developing in this way, you should avoid putting anything into the urethra (the tube that carries urine from the bladder out of the body), and stop using creams that cause discomfort around your genitals.
NGU can have some complications – for example, the condition can keep coming back.
Other complications include:
*reactive arthritis – when the immune system starts attacking healthy tissue, which can lead to joint pain and conjunctivitis
*epididymo-orchitis – inflammation of the testicles
Women often have no symptoms of NGU. However, if it’s caused by chlamydia and left untreated, it can lead to pelvic inflammatory disease (PID). Repeated episodes of PID are associated with an increased risk of infertility.