Nongonococcal Urethritis

What is nongonococcal urethritis?

Nongonococcal urethritis (NGU) is inflammation of the small tube that allows urine (pee) to exit your body (urethra). It’s commonly a sexually transmitted infection (STI) that occurs after having unprotected sexual intercourse with a partner who has an NGU infection. But there are also nonsexual causes. It can affect anyone, but men and people assigned male at birth (AMAB) are more likely to have NGU.

“Nongonococcal” means that germs other than gonorrhea cause the infection. “Urethritis” means inflammation of your urethra.

Another name for nongonococcal urethritis is nonspecific urethritis (NSU).

How common is nongonococcal urethritis?

Nongonococcal urethritis is very common. Healthcare providers treat nongonococcal urethritis more than any other STI in men and people AMAB.

What are the symptoms of nongonococcal urethritis?

In men and people AMAB, early symptoms may include:

• Leaking fluid (discharge) from your penis.
• Pain while peeing (dysuria).
• Pain while ejaculating (dysorgasmia or orgasmalgia).
• Itching, irritation and/or tenderness.
• Abdominal pain.

Without treatment, the infection can get worse. More severe NGU symptoms in men and people AMAB may include:

• Testicular pain and swelling.
• Infertility.
• Signs of infection that affect other parts of your body, including fever, chills, headache and feeling very tired (fatigue).

Women and people assigned female at birth (AFAB) usually have fewer NGU symptoms. But symptoms may include:

• Vaginal discharge.
• Pain while peeing.
• Pain during sexual intercourse (dyspareunia).
• Spotting or cramping throughout the month (irregular periods).

In some cases, people with NGU don’t have any symptoms.

What does urethritis feel like?

Urethritis feels uncomfortable. You may have a burning or stinging feeling when you pee or ejaculate. You may also feel an annoying itch inside your urethra that you can’t scratch.

What causes nongonococcal urethritis?

There are sexual and nonsexual causes of nongonococcal urethritis.

Sexual causes

STIs are the main cause of nongonococcal urethritis. You may pass STIs through unprotected vaginal, oral or anal sexual intercourse.

Many types of germs may cause NGU. The most common is chlamydia. But other common bacteria that cause NGU include:

• Haemophilus vaginalis (vaginalis).
• Mycoplasma genitalium (genitalium).
• Ureaplasma urealyticum (urealyticum).

The herpes simplex virus and Trichomonas vaginalis can also cause NGU. But it’s uncommon.

Nonsexual causes

Nonsexual NGU causes include:

• Foreskin that’s too tight (phimosis).
• Using a Foley catheter to drain pee from your urinary bladder during a medical procedure.
• Narrowing of your urethra (urethral stricture).
• Urinary tract infections (UTIs).

When do nongonococcal urethritis symptoms develop?

If you get NGU from bacteria, symptoms usually develop one to three weeks after infection. But you can also have NGU without any noticeable symptoms.

Who does nongonococcal urethritis affect?

Anyone can get NGU. But you’re more likely to get it if you have a penis. You may have a higher risk of developing NGU if you:

• Are between the ages of 15 and 30.
• Have unprotected sexual intercourse.
• Have more than one sexual partner.
• Experience trauma to your urethra; for example, you sustain an injury or use a Foley catheter.

What happens if NGU is left untreated?

NGU generally goes away without complications, even without treatment. It won’t likely cause long-term health effects. However, in rare instances, untreated NGU can lead to other complications, including:

• Epididymitis. This is inflammation in the tube behind your testicle (epididymis). Epididymitis can cause testicular pain.
• Reactive arthritis (Reiter’s syndrome). This is a type of arthritis that affects your back, joints, urinary tract and eyes.
• Skin lesions. These are changes to your skin.
• Vaginal infections. These may include mucopurulent cervicitis (MPC) and vaginitis. Untreated vaginal infections can lead to pelvic inflammatory disease and infertility.

It’s a good idea to schedule an appointment with a healthcare provider any time you notice symptoms that affect your genitals, especially when you pee or have sexual intercourse.

How is nongonococcal urethritis diagnosed?

Talk to a healthcare provider if you think you have NGU. They’ll review your health history and conduct a physical exam. They may also ask you questions about your sexual habits, including:

• Are you sexually active?
• Have you had unprotected vaginal, oral or anal sex in the past 60 days?
• Have you ever tested positive for an STI?
• Have any of your partners ever tested positive for an STI?

These questions may seem uncomfortable or intrusive. But providers aren’t judging you — they’re trying to make a diagnosis so you can feel better as soon as possible. It’s important to answer these questions honestly.

A provider may also order tests to help confirm their diagnosis.

What tests will be done to diagnose nongonococcal urethritis?

Usually, a healthcare provider will use a cotton swab to conduct a bacteria culture test from one of the following areas:

• Urethra
• Cervix.
• Rectum.
• Throat.

It’s possible to have multiple STIs at the same time. So, they may also order the following tests:

• Lab tests of your penile or vaginal discharge.
• Blood test.
• Urine test (urinalysis).

Can nongonococcal urethritis go away on its own?

Yes, NGU can go away on its own without treatment. But to protect your sexual partners and for your own peace of mind, it’s a good idea to schedule an appointment with a healthcare provider as soon as you notice symptoms of NGU.

How do you treat nonspecific urethritis?

Healthcare providers will prescribe antibiotics to destroy the germs that cause nongonococcal urethritis. A provider may prescribe:

• Doxycycline. You’ll take doxycycline twice a day for a week.
• Macrolide antibiotics, such as azithromycin. This is a single-dose medication.

If you’re allergic to these medications, or they don’t get rid of the infection, your provider may prescribe erythromycin or ofloxacin.

You and your partner(s) should receive treatment. If only one partner receives treatment, you may continue to pass NGU back and forth to each other.

How soon after treatment will I feel better?

It may take a week or two for your symptoms to go away after starting antibiotics.

Without treatment, NGU may go away on its own in a few weeks or up to six months.

How long is a person with NGU contagious?

You’re only able to spread NGU if it results from an STI. You’ll remain contagious until you finish your full course of antibiotics and your symptoms disappear.

Don’t have sexual intercourse until you finish your medicine and you no longer have any symptoms.

Can nongonococcal urethritis be prevented?

You can help prevent nongonococcal urethritis by:

• Using a new condom or dental dam each time you have sexual intercourse.
• Avoiding sexual intercourse if you suspect you or your partner have NGU or another STI.
• Getting tested for NGU and other STIs before having sexual intercourse with a new partner.
• Getting regular STI tests if you have multiple sex partners.

How serious is urethritis?

The overall outlook for nongonococcal urethritis is good. Most people make a full recovery a week or two after starting treatment. Your immune system can also typically clear it on its own after several months. However, you run the risk of spreading it to any other sexual partners. Long-term NGU complications aren’t common, though.

How long does non-STD urethritis last?

It depends on the exact cause. You may have irritation for only a few days after you remove a Foley catheter. More severe trauma may take a month or longer to heal. A healthcare provider will give you a more accurate estimate according to your specific cause.

Can I get NGU again?

Yes, you can get an NGU infection again. Having it once doesn’t protect you from getting it again.

How do I take care of myself?

After a healthcare provider diagnoses you and prescribes antibiotics, you can take the following steps to stay healthy:

• Take your medicine as directed by a provider. Finish your entire course of medicine, even if your symptoms improve. Don’t share your medicine with others.
• Pause your sex life. Don’t have sexual intercourse until you’ve finished your entire course of medicine and your symptoms go away.
• Avoid reinfection. Always use protection any time you have oral, vaginal or anal sexual intercourse.
• Contact your sexual partners. Get in touch with everyone you’ve had sexual intercourse with during the previous three months. Suggest that they talk to a provider and get tested as well.
• See a provider. If your symptoms don’t go away, or if they go away and come back, schedule another appointment with a provider.

When should I see a healthcare provider?

Schedule an appointment with a healthcare provider if you notice that you or your partner have any symptoms of NGU. It’s also a good idea to get annual (yearly) or more frequent STI testing if you’re sexually active with multiple partners.

What questions should I ask a healthcare provider?

• How do you know that I have NGU?
• Do I have sexual or nonsexual NGU?
• What treatment do you recommend?
• Should I get tested for other STIs?
• When can I resume having sexual intercourse?
• How can I protect myself in the future?
• Will I have any long-term health effects from NGU?
• Should I get regular STI testing?

Can you have nongonococcal urethritis without an STI?

Yes, you can have NGU without an STI. Trauma to your urethra may cause NGU.

Is NGU the same as gonorrhea?

No, nongonococcal urethritis isn’t the same as gonorrhea. They can lead to similar symptoms. But the bacterium Neisseria gonorrhoeae (N. gonorrhoeae) causes gonorrhea. A different type of bacteria or even trauma causes NGU. Therefore, gonorrhea and NGU need different treatments.