Nongonococcal Urethritis in Men
What is nongonococcal urethritis?
Nongonococcal urethritis (NGU) describes inflammation, or irritation, of the urethra. The urethra is a small tube in the penis which is the path urine (pee) follows from the bladder to leave the body.
This type of inflammation happens to men more than women. It’s usually caused by an infection, or germs entering the body. It’s a sexually transmitted infection (STI) that results from sex with an infected partner.
How common is nongonococcal urethritis?
NGU is the most commonly treated STI.
Symptoms and Causes
What are the causes of NGU?
There are sexual and nonsexual causes of nongonococcal infection.
Sexually transmitted infections (STIs) are the main cause of NGU. People can pass these infections to each other during unprotected sex — vaginal, oral or anal. The infections come from bacteria called Chlamydia trachomatis and Mycoplasma genitalium.
Nonsexual causes of NGU
Nonsexual causes of NGU include:
- Phimosis, where the foreskin is too tight.
- Catheterization, if you needed a tube inserted into the penis during a medical procedure.
Is NGU the same as gonorrhea?
NGU and gonorrhea are similar but different. Gonorrhea is a sexually transmitted infection caused by Neisseria gonorrhea. The two conditions can lead to similar symptoms. But there are crucial distinctions. The bacterium that causes gonorrhea is different than the bacteria that cause many cases of NGU. That’s reflected in part of NGU’s name — nongonococcal, or “no gonorrhea.” And it means the conditions need different treatments.
Who is at risk for NGU?
NGU is more common in men because the male urethra can get infected during sex. A woman’s urethra is much less likely to be infected during sex. Certain behaviors can also increase risk. Men between the ages of 15 and 30 who have more than one sex partner are more likely to get NGU.
Can women get nongonococcal urethritis?
Women are less likely to get NGU, but it can happen. NGU doesn’t cause as many symptoms in women.
What are the symptoms of NGU?
Women who get NGU often have fewer symptoms. In men, early symptoms may include:
- Discharge (leaking fluid) from the penis, either a little or a lot.
- Mild burning in the penis when peeing.
- Itching or irritation.
If you don’t get treatment, the infection can get worse. More severe symptoms in men include:
- Testicular pain and swelling.
- Infertility, where you’re unable to help make a baby.
- Illness from the infection spreading to other parts of the body.
Are there complications from NGU?
If you get medical care and follow treatment instructions, you most likely won’t have long-term health effects. But left untreated, the germs that often cause NGU can lead to complications like:
- Epididymitis, when the epididymis becomes inflamed. The epididymis is the rope-like structure along the testicles. This condition can lead to infertility and pain if untreated.
- Reiter’s syndrome, a form of arthritis.
- Skin lesions.
Women can also get other conditions from the same bacteria. These include:
- Mucopurulent cervicitis (MPC), an infection in the cervix. These infections can cause vaginal discharge (leaking), unusual bleeding from periods and pain during sex.
- Vaginitis, a group of vaginal infections that includes yeast infections.
When do symptoms of nongonococcal urethritis develop?
Men who get NGU from bacteria often develop symptoms 1 to 3 weeks after the infection starts. But you can also have NGU without any noticeable symptoms.
How long is a person with NGU contagious for?
With NGUs, you’re only contagious (able to spread) the problem if it’s an infection from sex. You remain contagious with the STI until you finish antibiotics and your symptoms go away. Don’t resume having sex until you’ve finished your medicine and your symptoms are gone.
Diagnosis and Tests
How do I know if I have NGU?
You may have symptoms, including pain or burning around the penis. Or perhaps you have no symptoms, but you had unprotected sex and want to get tested for STIs. Talk to your healthcare provider, who can diagnose any problems and get you the treatment you need.
What tests can diagnose NGU?
Usually, your provider diagnoses NGU when you:
- Have inflammation in your urethra and some of the symptoms above.
- Do not have gonorrhea.
For men or women, a urine sample, cotton swab of the throat, rectum or cervix can be used to test for NGU.
The medical team will test the fluid for the germs that cause gonorrhea, chlamydia and maybe Mycoplasma genitalium. Symptoms of those infections are similar to NGU symptoms. People can catch multiple STIs at the same time. Your provider may also test for HIV and other STIs.
Management and Treatment
What’s the treatment for nongonococcal urethritis?
Antibiotics are used to treat NGU. These medications destroy the germs that are responsible for the infection. Your provider may prescribe:
- Doxycycline, which you take twice a day for a week.
- Macrolide antibiotics, such as azithromycin, which is a single-dose medication.
If you’re allergic to these drugs, or they don’t work, your provider will prescribe different medications. You and your partner both need treatment. If only one partner is treated, you may continue to pass the infection back and forth to each other.
How can I prevent nongonococcal urethritis?
You can prevent NGU by using a new condom or dental dam every time you have sex. If you have a new partner, consider getting tested for NGU and other STIs before having sex. If you have multiple sex partners, talk to your healthcare provider about regular STI testing. Many providers recommend yearly testing, or more frequently if appropriate, for people who are sexually active. This testing can keep you and your partners safe.
Outlook / Prognosis
Can I get NGU again?
Yes, you can get the infection again. Having it once doesn’t protect you from getting it again.
What should I do after treatment for nongonococcal urethritis?
After your provider has diagnosed NGU and prescribed antibiotics, take steps to stay healthy:
- Use medicine as directed: Take all the medicine you were prescribed. Finish your medication, even if your symptoms improve. Don’t share your medicine with others.
- Pause your sex life: Don’t have sex until you’ve taken all of the medicine and your symptoms are gone.
- Avoid reinfection: Always use condoms and dental dams for vaginal, oral and anal sex.
- Contact sexual partners: Get in touch with everyone you’ve had sex with during the last three months. Suggest that they get treated.
- See your provider: If the discharge doesn’t go away (or if it goes away and comes back), contact your healthcare provider.
What should I ask my healthcare provider?
If you have NGU or suspect you do, ask your provider:
- What treatment will work best?
- Should I get tested for other STIs as well?
- When can I resume having sex?
- How can I protect myself in the future?
- Are there long-term health effects from NGU?
- Should I have regular STI testing?
A note from Cleveland Clinic
Nongonococcal urethritis, or NGU, is inflammation of the urethra. The main cause of NGU is having unprotected sex with an infected person. But there are nonsexual causes of NGU as well, including UTIs. If you have symptoms of NGU, such as discharge from the penis or pain while you pee, talk to your healthcare provider. If you don’t have symptoms but had unprotected sex, it’s a good idea to talk to your provider as well. Many people don’t get NGU symptoms but can still carry an infection and pass it to their partners. Antibiotics can usually clear up any infections. Use a condom or dental dam every time you have sex to prevent NGU.
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