Non-specific urethritis

Page last reviewed: 13/07/2011

Urethritis is inflammation of the urethra. The urethra is the tube that carries urine from the bladder out of the body.

Urethritis is usually caused by infection, although this is not always the case. The term non-specific urethritis (NSU) is used when the cause of the urethritis has not yet been identified, but it is known that gonorrhoea, a sexually transmitted infection (STI), is not responsible.

See the Health A-Z topic about Gonorrhoea for more information about this condition.

NSU can have a number of possible causes, but it is estimated that the STI chlamydia is responsible for nearly half of all male cases.

See the Health A-Z topic about Chlamydia for more information about this condition.

How common is non-specific urethritis?

Urethritis is one of the most common reasons for men to visit their local genitourinary medicine (GUM) clinic or sexual health clinic. It is more difficult to diagnose urethritis in women because it may not cause as many symptoms.

Outlook

NSU is usually treated with antibiotics (medicines to treat bacterial infections) and the symptoms usually go away within two weeks. It is important that past and current sexual partners are also treated to prevent any infection spreading to other people. See NSU - treatment for more information.

Women often have no symptoms of NSU, but if it is caused by chlamydia it can lead to pelvic inflammatory disease (PID) if it is not treated. See the Health A-Z topic about PID for more information about this condition. Repeated episodes of PID are associated with an increased risk of infertility.

Inflammation
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.
Urethra
The urethra is the tube that carries urine from the bladder to the outside of the body.

Page last reviewed: 13/07/2011

Non-specific urethritis (NSU) can cause different symptoms in men and women. In some cases, NSU does not cause any symptoms at all.

Symptoms of NSU in men

The symptoms of NSU in men can include:

  • a white or cloudy discharge from the tip of the penis 
  • a burning or painful sensation when you urinate
  • the tip of your penis feeling irritated and sore
  • a frequent need to urinate

Depending on the cause of NSU (see NSU - causes), symptoms may begin a few weeks after an infection or several months later. If NSU has a non-infectious cause, 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 NSU, but you don't have any symptoms, don't assume that you do not have NSU. In these circumstances, it is always recommended that you visit your local genitourinary medicine (GUM) clinic or sexual health clinic for testing.

Symptoms of NSU in women

NSU tends to cause no noticeable symptoms in women unless the infection manages to spread 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.

Symptoms of PID include:

  • pain around the pelvis or lower part of your tummy 
  • discomfort or pain during sexual intercourse that is felt deep inside the pelvis
  • bleeding between periods and after sex
  • unusual vaginal discharge
  • a high temperature (fever) of 38°C (100.4°F) or above 

See the Health A-Z topic about PID for more information about this condition.

Discharge
Discharge is when a liquid such as pus oozes from a part of your body.
Ovaries
Ovaries are the pair of reproductive organs that produce eggs and sex hormones in females.
Vagina
The vagina is a tube of muscle that runs from the cervix (the opening of the womb) to the vulva (the external sexual organs).
Womb
The womb (or uterus) is a hollow, pear-shaped organ in a woman where a baby grows during pregnancy.

Page last reviewed: 13/07/2011

Some of the possible causes of non-specific urethritis (NSU) are explained below. For urethritis that is caused by gonorrhoea, see the Health A-Z topic about Gonorrhoea.

Chlamydia

The sexually transmitted infection (STI) chlamydia is thought to be responsible for almost half of all cases of NSU in men. In women, about 4 out of 10 cases of NSU may be caused by chlamydia.

Chlamydia is caused by Chlamydia trachomatis bacteria and is spread during unprotected sex, including anal and oral sex. See the Health A-Z topic about Chlamydia for more information about this condition.

Other infections

A number of other infections can cause NSU.

This includes other bacteria that usually live harmlessly in the throat, mouth or rectum (where waste material is stored and passed from the body). They can cause NSU if they manage to find their way into the urethra, which is the tube that carries urine from the bladder to the outside of the body. This can often occur during oral or anal sex.

Possible infections that can cause NSU include:

  • Trichomonas vaginalis, which is an STI caused by a tiny parasite
  • other bacteria, for example Mycoplasma
  • urinary tract infection 
  • the herpes simplex virus, which can also cause cold sores and genital herpes 
  • an adenovirus, which usually causes a sore throat or an eye infection

Non-infectious causes

It is possible for NSU to have a non-infectious cause. This is when something else leads to the urethra becoming inflamed (red and swollen). Non-infectious causes of NSU include:

  • irritation from a product used in the genital area, such as soap, deodorant or spermicide
  • damage to the urethra caused by vigorous sex or masturbation
  • damage to the urethra caused by inserting an object into it, for example when a catheter (thin, plastic tube) is inserted to allow urine to drain from the bladder, for example during an operation in hospital
Inflammation
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.
Bacteria
Bacteria are tiny, single-celled organisms that live in the body. Some can cause illness and disease and some others are good for you.
Urethra
The urethra is a tube that carries urine from the bladder to the outside of the body.
Urinary tract
The urinary tract is made up of the kidneys, the ureters (the tubes that carry urine from the kidneys to the bladder), the bladder and the urethra.

Sexually transmitted infections (STIs)

Urethritis can be caused by a sexually transmitted infection (STI). It is therefore more common among people who are at risk of STIs. This includes people who:

  • are sexually active
  • have had unprotected sex
  • have recently had a new sexual partner

Page last reviewed: 13/07/2011

If you think you have non-specific urethritis (NSU), you should visit your local genitourinary medicine (GUM) clinic or sexual health clinic. These clinics have access to specialist diagnostic equipment that is probably not readily available to your GP.

Sexual health services are free and available to everyone regardless of sex, age, ethnic origin and sexual orientation.

Possible tests

There are two tests that are often used to diagnose NSU. Either test can be used, although both may be carried out to ensure that the diagnosis is correct.

It is recommended that you are also tested for gonorrhoea and chlamydia at the same time as NSU. These are two sexually transmitted infections (STIs) that often cause urethritis.

You may also be offered tests for other STIs, including HIV. It is up to you whether to have these or not, but a test for all infections is recommended. You can discuss this with the healthcare professionals at the clinic if you wish. 

Swab test

A swab test involves taking a small sample of cells from your urethra, which is the tube that carries urine from the bladder to the outside of the body. The cells can then be examined under a microscope to look for evidence of inflammation or bacteria known to cause NSU.

The cells are taken using a swab, which is like a small cotton bud with a plastic loop at the end. The swab is not painful but can feel a little uncomfortable for a few seconds.

Urine test

Men will be asked to provide a urine sample so that this can be tested for bacteria known to cause NSU, for example chlamydia and gonorrhoea.

You will be asked not to urinate for around two hours before providing a urine sample, because this can help improve the reliability of the test results. Ideally, you should hold your urine for at least 4 hours before having the tests done.

Results

Clinics that have microscope facilities will be able to give you some initial results the same day. Other clinics may need to send the samples to a laboratory for testing, in which case the test results may not be available for a week or two.

The healthcare professionals at the clinic will tell you how and when you will receive your test results and will arrange your treatment.

What happens at a sexual health clinic?

  • Some clinics are walk-in clinics and at some you need to book an appointment. Phone the clinic to find out. You do not need a referral from your GP.
  • When you attend a clinic, you will be asked to fill in a form with your name and contact details. Any details you give will be confidential. 
  • You will be asked why you have attended the clinic. 
  • You will be asked about your sexual history, for example, when you last had sex, whether you used condoms and whether you have had an STI before.
  • If you are attending the clinic for non-specific urethritis (NSU), you will be offered tests for STIs. You do not have to agree, although it is recommended. Tests can only be done with your consent.
  • You will need to give a urine or blood sample for some STI tests. 
  • The results of some tests will be available straight away. Others need to be sent to a laboratory and will take a week or two.
  • If you need any treatment, this will be discussed with you. 
  • If you have an STI, your partner (and any recent partners) will need to be tested and, if necessary, treated to prevent the infection being passed on to anyone else.  
  • Staff at the sexual health clinic will be able to advise you about the sexual partners who will need to be contacted, and may be able to contact them on your behalf. If you wish, your anonymity will be protected when contacting your previous sexual partners.

Page last reviewed: 13/07/2011

If you are diagnosed with non-specific urethritis (NSU), the infection will usually be treated with antibiotics (medicines to treat bacterial infections). 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. See the Health A-Z topic about Gonorrhoea - treatment for more information.

Antibiotics

Treatment with antibiotics may be started before you receive your test results (see NSU - diagnosis for information about the tests). If your test results then indicate that your NSU is not due to a bacterial infection, treatment with antibiotics will be stopped.

Most people with NSU 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

In some cases it may 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

Side effects

Antibiotics may cause some side effects, such as:

  • feeling sick
  • vomiting
  • diarrhoea

For more information on all the different side effects and interactions of your medication, see the patient information leaflet that comes with it

.NSU and sexually transmitted infections (STIs)

While not all cases of NSU are caused by a sexually transmitted infection (sexually transmitted infection (STI), it is possible to pass on NSU during sex. Therefore, you should treat all cases of NSU 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 that the condition has cleared up.

NSU does not tend to cause any noticeable symptoms in women, but it can still affect a woman's long-term health. The bacteria associated with NSU can trigger the development of pelvic inflammatory disease (PID). 

Therefore, you should always inform your current partner and any recent sexual partners if you are diagnosed with NSU. They will also need to be tested and treated for the condition.

Informing partners

It is important that your current sexual partner is tested and treated. Any sexual partners that you have had since being exposed to the STI will also need to be informed, so that they can also be tested and treated.

It is suggested that you inform any person that you have had sex with in the last three months, but this time frame can vary. The healthcare professionals at the GUM clinic will be able to advise you.

Some people can feel angry, upset or embarrassed about discussing STIs with their current partner or previous partners. However, do not be afraid to discuss your concerns with the healthcare professionals at the GUM or sexual health clinic. They will be able to advise you further about who should be contacted 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:

Ectopic pregnancy
An ectopic pregnancy occurs when a fertilised egg implants itself outside the womb.

Treatment failure

If the symptoms of non-specific urethritis (NSU) 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 since then you have had sex with anyone who may have NSU and has not been treated, as they 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). See NSU - diagnosis for more information about these tests. 

In some cases you may be given a new prescription for some different antibiotics to treat the NSU.

Page last reviewed: 13/07/2011

There are some possible complications of non-specific urethritis (NSU).

Persistent urethritis

The most common complication is persistent or recurrent urethritis. This is when you still have urethritis one to three months after being treated for NSU. This affects one or two men in every ten who are treated for NSU.

If you still have symptoms two weeks after you start to take antibiotics, you should return to the genitourinary medicine (GUM) clinic or sexual health clinic. See NSU - treatment for more information.

Reiter's syndrome

Reiter's syndrome, also known as reactive arthritis, is an uncommon complication of NSU. It is estimated that Reiter's syndrome will affect less than 1 in 100 people with NSU.

Reiter's syndrome is caused by the immune system (the body's natural defence system). For reasons that are not fully understood, the immune system begins to attack healthy tissue, rather than the bacteria that are responsible for NSU. This can cause:

  • joint pain
  • conjunctivitis (inflammation of the eyes)
  • recurring urethritis

Epididymo-orchitis

Epididymo-orchitis is a possible complication of NSU in men. It is a combination of epididymitis and orchitis:

  • epididymitis is inflammation (redness and swelling) of the epididymis, which is a long coiled tube in the testicles that helps store and transport sperm
  • orchitis is inflammation of the testicles

Epididymo-orchitis affects less than 1 in 100 men with NSU.

Immune system
The immune system is the body's defence system, which helps protect it from disease, bacteria and viruses.
Inflammation
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.

Page last reviewed: 13/07/2011

Most cases of non-specific urethritis (NSU) are caused by a sexually transmitted infection (STI). The best way to protect yourself against STIs is to practise safe sex by always using a condom when you have sex, including vaginal, oral and anal sex.

Safe sex

If you are sexually active, having safe sex offers you and your partner the best protection against STIs. Following the advice below will enable you to have a safer sex life.

  • Keep the number of sexual partners that you have to a minimum. 
  • Use a barrier method of contraception, such as condoms, every time you have vaginal or anal sex. 
  • If you have oral sex, cover the penis with a condom or the female genitals with a latex or plastic square (dam). 
  • If you are not sure how to use a condom, see the Health A-Z topic about Condoms - how to use a condom
  • Avoid sharing sex toys. If you do share them, make sure that you wash them 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 you 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.

These measures can help protect you against STIs or, if you have an STI, will prevent you from passing it on to your partner.

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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