Non-specific urethritis

Urethritis is inflammation (pain, redness and/or swelling) of the urethra (tube where urine comes out). Sometimes it is called non-specific urethritis (often known as NSU) or non-gonococcal urethritis (NGU).

In this information we use the term non-specific urethritis. This means inflammation of the urethra when the cause is not yet known and the sexual infection gonorrhoea (which can cause inflammation) has been ruled out.

It is possible for men and women to have non-specific urethritis but it is more difficult to diagnose in women.

This information only discusses non-specific urethritis in men. It gives you information about non-specific urethritis, what you can do if you are worried you might have it and advice on how to protect yourself.

Non-specific urethritis (PDF)

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

If you have signs of inflammation in your urethra it is common to be told you have non-specific urethritis straightaway, before the cause is known. You will probably be tested for sexually transmitted or possibly urinary tract infections to try to find out what the cause of the inflammation is. You may have to wait for these results.

Causes of non-specific urethritis include:

Sexually transmitted infections

  • Chlamydia is a common cause of non-specific urethritis.
  • Genital herpes and trichomonas vaginalis are less common causes.

Other organisms

  • Tiny organisms called mycoplasma genitalium and ureaplasma urealyticum can live in the body without causing symptoms but sometimes they multiply quickly, leading to inflammation of the urethra. Being ill or stressed could cause this to happen. It is thought these organisms may be transmitted sexually.
  • Some bacteria that live in the rectum and the mouth and throat can be passed on during sex and cause inflammation.
  • Bacteria that cause infection in the urinary tract (kidneys, bladder and urethra) or the prostate gland can lead to inflammation of the urethra.
  • A vaginal infection in your partner, such as thrush or bacterial vaginosis, may trigger non-specific urethritis in you.

Damage to the urethra

This can be caused by friction during vigorous sex or masturbation, or inserting objects into the urethra. Frequently inspecting or squeezing your urethra can also irritate it and cause inflammation – some men do this if they have recently had an infection or they are worried they might have one.

Antibacterial liquids

Applying liquids such as tea tree oil, antiseptic or disinfectant or using medicated or highly perfumed shower gels can cause inflammation.

Sensitivity or irritation

Rarely, inflammation can occur if your skin is very sensitive to chemicals, such as those in latex (in condoms, for example), spermicide or soap.

During unprotected vaginal, anal or oral sex, organisms which cause inflammation can pass into the urethra. Non-specific urethritis can occur in any man who is sexually active. You don’t need to have lots of sexual partners.

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

You cannot get non-specific urethritis from kissing, hugging, sharing baths or towels or from toilet seats.

Not all men who have inflammation will show any signs or symptoms, or they may be so mild they are not noticed.

If signs and symptoms do occur they usually show up within 2–4 weeks of contact with an infection, but they can sometimes appear within a day or two (depending on the cause of the inflammation). In mild cases, symptoms may not show up for several months. If you do get signs and symptoms you might notice:

  • A white or cloudy discharge from the tip of the penis, usually more noticeable first thing in the morning. Sometimes this discharge is seen only when massaged out of the penis.
  • Difficulty, pain or a burning sensation when passing urine.
  • The feeling that you need to pass urine frequently.
  • Itching or irritation at the end of the urethra.

Depending on the cause of the inflammation there may also be other symptoms that are specific to particular infections.

You can only be certain if you have a test. Because the inflammation can be caused by sexually transmitted infections you may wish to be tested for infection if:

  • you have, or think you might have, symptoms
  • you have recently had unprotected sex with a new partner
  • you or your partner have had unprotected sex with other partners
  • a sexual partner tells you they have a sexually transmitted infection.

It is important that you don’t delay getting a test if you think you may have an infection. You can have a test even if you haven’t got symptoms. It is possible to be tested for signs of inflammation within a few days of having sex, but it may be necessary to wait up to two weeks before you can do a test to check for infections such as chlamydia. Routine tests for mycoplasma genitalium and ureaplasma urealyticum are not currently widely available in the UK but may be offered at some clinics, particularly to men with persistent non-specific urethritis..

As well as testing for signs of inflammation it is recommended that you also have a test for chlamydia and gonorrhoea at the same time. The type of sample that is collected will depend on whether you have any signs and symptoms and what infections you are being tested for.

The tests may involve a doctor or nurse:

  • using a swab to collect a sample of cells from the entrance of the urethra
  • asking you to give a urine sample
  • examining your penis.

A swab looks 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 is wiped over the parts of the body that could be affected and easily picks up samples of discharge and cells. It only takes a few seconds and is not usually painful, though it may be uncomfortable for a moment.

In some services they can look at the sample under the microscope straightaway and tell you if there are signs of inflammation. It may also be possible to give you the results of tests for other sexually transmitted infections straightaway. You may, however, have to wait 1–2 weeks to find out if the non-specific urethritis is being caused by a sexually transmitted infection or is due to other infection in the urinary tract.

Routine blood tests do not detect non-specific urethritis. If you are not sure whether you have been tested just ask.

The accuracy of looking for signs of inflammation under the microscope depends on the skill of the person doing the test and how long ago 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.

You may be tested for various causes of non-specific urethritis, and these tests have different levels of accuracy.

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.

There are a number of services that you can go to. Choose the service you feel most comfortable with. A test can be done at:

  • a genitourinary medicine (GUM) or sexual health clinic
  • general practices
  • some contraception and young people’s clinics.

All tests are free through NHS services. Treatment is also free unless you go to your general practice when you may have to pay a prescription charge for the treatment.

Non-specific urethritis is treated with antibiotics.

  • If the test shows that inflammation is present, or if there is a high chance that you have an infection, you will be given treatment even if the cause is not yet known.
  • There are several different antibiotics that can be used, either as a single dose or a longer course (up to two weeks).
  • Some men may get non-specific urethritis more than once, and for a few men it may become persistent (keep coming back). If this happens, you may be given a second course, or a combination, of antibiotics.
  • You may also need other treatment if complications have occurred (see below, What happens if non-specific urethritis isn't treated?) or the cause of the inflammation becomes known.
  • There is no evidence that complementary therapies can cure non-specific urethritis.

Most men notice an improvement in the symptoms quite quickly, with the discharge and pain on passing urine usually improving within a week.

Some services may ask you to go back and see them for a check-up two weeks later, and some may do a follow-up on the phone. This is to:

  • check that the signs and symptoms have gone
  • check that you were able to take the treatment correctly
  • check that you have not been exposed to an infection again
  • give you the results of any other tests that were done, and give you advice on how to get further treatment if necessary
  • answer any questions you have and give you any advice you need on protecting yourself from infection.

If you still have signs or symptoms you may need to be tested again and have more treatment.

If non-specific urethritis is detected and treated early there are no complications. If left untreated, some causes of non-specific urethritis can have long term consequences, although these are uncommon. They can include:

  • Painful infection in the testicles.
  • Possible reduced fertility.
  • Inflammation of the joints. This is known as reactive arthritis. Sometimes reactive arthritis is accompanied by inflammation of the eyes as well as the urethra – if this happens it is known as Reiter’s Syndrome.

Non-specific urethritis caused by chlamydia can lead to pelvic inflammatory disease (PID) in your female sexual partner(s). This can lead to long term pelvic pain, blocked fallopian tubes, infertility and ectopic pregnancy (when the pregnancy develops outside the uterus).

It is not known whether some other causes of non-specific urethritis (for example, mycoplasma genitalium) can lead to PID but it is thought that it may be possible.

This will depend very much on the cause. If you delay seeking treatment you risk an infection causing long-term damage and you may pass the infection on to someone else.

It is strongly advised that you do not have any sexual intercourse, including vaginal, anal or oral sex until you and your partner have both finished the treatment and any follow-up treatment. This is to help prevent you being reinfected or passing the infection on to someone else and to allow the urethra to heal.

The tests cannot tell you how long the infection has been there. If the non-specific urethritis has been caused by a sexual infection and you have had more than one sexual partner, it can be difficult to know which partner it came from.

If you feel upset or angry about having an infection and find it difficult to talk to your partner or friends, don’t be afraid to discuss how you feel with the staff at the clinic or general practice.

Because non-specific urethritis is often caused by a sexually transmitted infection it is very important that your current sexual partner(s) and any other recent partners are also tested and treated. The staff at the clinic or general practice can discuss with you which of your sexual partners may need to be tested.

You may be given a ‘contact slip’ to send or give to your partner(s) or, with your permission, the clinic can do this for you. The slip explains that they may have been exposed to a sexually transmitted infection and suggests that they go for a check-up. It may or may not say what the infection is. It will not have your name on it, so your confidentiality is protected. This is called partner notification. You are strongly advised to tell your partner(s), but it isn’t compulsory.

In some men who are not responding to treatment, non-specific urethritis may only clear up after their partner has been treated too.

Sexual infection is just one of many factors that can affect your fertility. Having non-specific urethritis will not affect the fertility of most men.

If you have had non-specific urethritis you will not normally be offered any routine tests to see if you are fertile unless your partner is having difficulty getting pregnant. If you do not want your partner to get pregnant, it is still important to use contraception. You should not assume you are infertile. If you are concerned, talk to your doctor or practice nurse.

It is possible to get non-specific urethritis and other sexually transmitted infections by having sex with someone who has an infection but has no symptoms.

The following measures will help protect you from non-specific urethritis and most other sexually transmitted infections, including HIV, gonorrhoea and chlamydia. If you have a sexually transmitted infection they will also help prevent you from passing it on to your partner.

  • Use condoms (male or female) every time you have vaginal or anal sex.
  • If you have oral sex, use a condom to cover the penis, or a latex or polyurethane (soft plastic) square to cover the female genitals or male or female anus.
  • Avoid sharing sex toys. If you do share them, wash them or cover them with a new condom before anyone else uses them.
  • If you are not sure how to use condoms correctly see our information on condoms.

Another way to help protect yourself against non-specific urethritis is to avoid putting objects, lotions and creams into your urethra.

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This website can only give you general information about sexually transmitted infections. The information is based on evidence-based guidance produced by The British Association for Sexual Health and HIV (BASHH).

Remember – contact your doctor, practice nurse or a clinic if you are worried or unsure about anything.

INFORMATION LAST UPDATED JANUARY 2014. NEXT PLANNED REVIEW 2017.