What is urethritis?

The urethra is the tube between the bladder and the end of the penis. Urethritis means inflammation of the urethra.

• Gonococcal urethritis is caused by a bacterium (germ) called Neisseria gonorrhoeae. This is one type of sexually transmitted infection. See separate leaflet called 'Gonorrhoea', which describes gonorrhoea in more detail.
• Non-gonococcal urethritis (NGU) is due to causes other than gonorrhoea. This used to be called nonspecific urethritis (NSU). This leaflet describes NGU further.
• Some men have both gonococcal and non-gonococcal urethritis at the same time.

What causes non-gonococcal urethritis?

• Infection with chlamydia causes about half of cases of NGU. Chlamydia is a bacterium (germ) that is usually caught by sexual contact with an infected person. You can pass chlamydia on during vaginal, anal or oral sex.
• Various other bacteria or viruses which are sexually transmitted can cause NGU.
• A non-infective problem is, rarely, the cause. For example, injury from a catheter, surgery to the urethra, a narrowing of the urethra (stenosis) or conditions affecting the lining of the urethra can cause inflammation.
• No cause can be found in about 3 in 10 cases. Sexually transmitted infections that are not identified by tests are probably the cause of some of these but not all. However, it is not possible to say which of these cases are due to infection and which are not.

Who gets urethritis?

You are at higher risk of getting urethritis if you are sexually active, aged under 35 and have had a recent partner change. Men who have sex with men and those who have unprotected vaginal intercourse are also at higher risk.

What are the symptoms of non-gonococcal urethritis?

• A white discharge (fluid) from the end of the penis is common but does not occur in every case.
• Pain or burning when you pass urine. This may be confused with a urine infection.
• Irritation inside the penis.
• A feeling of wanting to pass urine frequently.
• In a small number of cases the infection travels up the urethra to the testes and causes pain and swelling in one or both testes.
• A rare complication is a type of arthritis which can be triggered by NGU. It may be due to the immune system over-reacting to some bacteria that can cause NGU.
• Up to half of men with chlamydial infection (the most common cause of NGU) do not have any symptoms.

The symptoms may clear over time, even without treatment. This may take up to six months but can be just a couple of weeks or so. However, without treatment, bacteria that cause NGU often remain in the urethra. It is just that the symptoms may go.

Therefore, even if symptoms go, there is a good chance that you can pass on the infection if you are not treated.

Do I need tests?

You will normally be advised to have tests if NGU is suspected - even if symptoms go. You may be referred to a local genitourinary (GUM) clinic for this. Some GPs now also provide treatment for sexual health conditions as an 'enhanced service'. You can also go to the local GUM clinic without a referral from your GP. (See the end of the leaflet for details.)

A urine specimen may be taken to try to identify the cause of the infection. You may also be advised to have tests for other sexually transmitted infections such as a swab from the urethra or blood tests. Men who have sex with men may also be advised to have a swab from the back of the throat (pharynx) and rectum.

What is the treatment for non-gonococcal urethritis?

A short course of antibiotics usually clears NGU. The antibiotic prescribed may depend on which bacteria are found (often chlamydia) and whether other infections are also present.

If no bacteria are found by the tests, you may still be advised to take a course of antibiotics if you have symptoms of NGU. Infection is still the likely cause, even if a bacterium cannot be identified.

Most people get better with antibiotic treatment. It is important to finish the whole course.

Does my sexual partner need treatment?

Yes. They should be tested for infection, even if they do not have any symptoms. A course of antibiotics is usually advised for sexual partners, even if the tests are negative, because:

• Many women who are infected with chlamydia do not have symptoms. If this is left untreated, it can cause complications at a later time, such as a serious infection of the uterus (pelvic inflammatory disease) and infertility.
• Bacteria that cause NGU are often passed on during sex. Some of these bacteria may cause pelvic inflammatory disease in women. Tests for bacteria are not foolproof. A course of antibiotics helps to make sure that any possible infection is cleared.
• If your sexual partner is infected and not treated, the infection can be passed back to you.

If you have NGU without symptoms, then you may have had it for some time. In this situation, any sexual partners within the previous six months should be tested and treated.

Follow-up

A doctor or healthcare professional will often want to know that treatment has worked. It is common to be reviewed a couple of weeks after you start treatment to check that symptoms have gone. Sometimes re-testing and a second antibiotic are needed if symptoms persist.

You should not have sex until both you and your sexual partner(s) have finished treatment.

Can non-gonococcal urethritis be prevented?

Wearing a condom during sex (including anal and oral sex) helps to prevent the spread of sexually transmitted infections. The risk of sexually transmitted infections increases with the number of changes of sexual partner.

Further help and information

If you suspect that you have NGU or any other sexually transmitted infection, then contact your local GUM clinic or see your GP. You can go to the local GUM clinic without a referral from your GP. You can ring the local hospital or health authority and ask where the nearest clinic is. It may also be listed in the phone book under 'Genito-Urinary Medicine'.

fpa

Helpline: 0845 122 8690 Web: www.fpa.org.uk
Provides information and advice on all aspects of contraception and sexual health.

British Association for Sexual Health and HIV (BASHH)

Web: www.bashh.org
A professional association but their website includes contact details of GUM clinics.

Chlamydiae.com

Web: www.chlamydiae.com
The comprehensive reference and education site for chlamydia and the chlamydiae. By the University of Southampton.

National chlamydia screening programme website

Web: www.chlamydiascreening.nhs.uk
Includes information about the national screening programme to detect young people with chlamydia who do not have symptoms.

References

• Management of chlamydia trachomatis genital tract infection, British Association for Sexual Health and HIV (2006)
• Standards for the management of sexually transmitted infections, British Association for Sexual Health and HIV (2010)
• Plewa M, Male Urethritis in Emergency Medicine, Medscape, Apr 2010
• Guidelines on Urological Infections, European Association of Urology (2011)
• Urethritis - male, Prodigy (September 2009)