Non-Specific Urethritis

The urethra is the tube that carries urine in women, and urine and sperm in men, out of the body.

When this tube becomes inflamed or infected by bacteria it develops into non-specific urethritis. If the infection is not caused by gonorrhoea it is often called non-gonococcal urethritis. Other terms used to describe the condition include NSU, NGU and non-gonococcal genital infection.

Sometimes non-specific urethritis can be caused by a catheter or from an allergic reaction to creams or soaps. It is not an STI in the general sense, but it can be caught via and spread by sex.

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

The symptoms are different for men and women with the same infection:

In men these symptoms include:

• Cloudy or white discharge from the penis
• Pain on urination
• The penis tip feeling sore
• Needing urinate frequently

You should seek treatment if the symptoms disappear as there is still a risk you could pass the infection on to someone else.

In women the symptoms include:

• Abdominal pain
• Painful sex with pain felt deep inside the vagina near to the cervix
• Irregular bleeding between periods and after sex
• Painful urination
• Painful periods
• Vaginal discharge that is a different colour such as yellow or green

Non-specific urethritis is more difficult to identify in women because it does not always cause noticeable symptoms. Sometimes the infection is only picked up when it has spread to cause pelvic inflammatory disease (PID). This is when infection spreads to the fallopian tubes, womb and ovaries.

Pelvic inflammatory disease can cause:

• Severe lower abdominal pain
• A high temperature
• Nausea and vomiting
• >Eventual infertility

There are numerous ways to catch or develop non-specific urethritis. In some cases a cause is not found, in others, more than one cause is identified, but this does not prevent treatment.

The main way individuals get non-specific urethritis is due to a sexually transmitted infection. Chlamydia is thought to make up nearly half of all cases. Chlamydia is a bacterial infection spread via unprotected, vaginal, anal and oral sex. Other STIs that cause non-specific urethritis are:

• Gonorrhoea, although this does not cause non-specific urethritis, instead it can cause gonococcal urethritis
• Herpes - an incurable but manageable viral infection
• Trichomonas vaginalis which is an STI caused by a tiny parasite
• Mycoplasma bacteria which causes mycoplasma genitalium and ureaplasma urealyticum. When these multiply quickly they can lead to inflammation of the urethra.

Other non STI causes include:

• Bacteria that lives harmlessly on your skin, such as in your throat or mouth, does not usually cause a problem. If it enters the urethra bacteria can breed rapidly and develop into non-specific urethritis. This can happen through oral sex.
• Allergy or irritation from a wash product such as shower gel or bath foam particularly those with antibacterial ingredients such as tea tree or lavender oils. Spermicide and lubricants can also lead to inflammation and non-specific urethritis.
• Damage to the urethra during sex or masturbation by pulling or causing excessive friction on the tube.
• Inserting an object, a catheter for example.
• Thrush or bacterial vaginosis, either from your own body or transferred from your partner.
• Urinary tract infections, such as cystitis.

If you feel you have any kind of symptoms in your genital or urinary tract don't wait to see if it disappears, seek treatment immediately so you can avoid any complications.

Your local sexual health clinic can provide tests and information on what to do if you have symptoms in your genitals or you are aware that your partner has symptoms but you are not showing any signs of infection.

There are two tests that can identify non-specific urethritis - a swab test and a urine test.

• The swab test involves taking a small sample from your urethra for examination under a microscope. It's taken using a small cotton bud. Usually, women are required to have a swab test.
• The urine test involves peeing into a container for a bacteria examination

Not all clinics will have the necessary equipment to diagnose you right away. It may take a week or so for results to be passed back. In this case, if you are presenting symptoms you will be treated immediately.

Whilst you are having tests for non-specific urethritis you are likely to be offered tests for other STIs. If you have contracted non-specific urethritis through sex, you may have picked up another infection. Chlamydia and other STIs can cause non-specific urethritis and often have no symptoms, particularly in women. In women, untreated chlamydia can cause infertility.

Most STIs are treatable with antibiotics. Herpes, genital warts and HIV are not but they can be managed with medical assistance. Because chlamydia and gonorrhoea can cause urethritis is highly recommended you are tested for these infections.

It is possible to buy home testing kits to test for STIs, but these are not as accurate as laboratory tests. If you want to use a home testing kit ensure you obtain it from a well-respected source or ask your doctor for advice.

Although the symptoms of non-specific urethritis can be distressing it is easily treated with a quick course of antibiotics to kill the bacteria.

The antibiotics generally used to treat non-specific urethritis are Azithromycin and Doxycycline. Azithromycin is a single convenient dose, whereas Doxycycline is taken twice a day for a week. Your doctor will decide which is suitable given the cause of your infection and its severity.

Sometimes it can take a few weeks for the symptoms to go completely, but as long as you have taken your course properly the infection will have cleared.

Be aware that antibiotics can affect the contraceptive pill. It's recommended you do not have sex during your treatment for non-specific urethritis, as you risk irritating the urethra and passing the infection. If you do have sex, ensure you are protected against pregnancy by using condoms for the duration and seven days following your treatment.

Antibiotics are likely to clear your infection the sooner you take it, so don't delay getting treatment.

You must finish the entire course if you are prescribed Doxycycline. Don't leave antibiotics just in case you think you'll need them at a later date. If you don't finish the course then some infection may remain and will grow into a second infection. This will require a further course of antibiotics. Taking too many antibiotics leads to resistant bacterial strains that are hard to treat.

If you have non-specific urethritis infection it's likely your partner will have it too. Unless you seek treatment together you are likely to pass the infection back and forth.

Non-specific urethritis is easily treated, so there is no reason to avoid a course of antibiotics. Without them, you risk spreading the infection to others and developing further complications which, although rare, can be serious including:

Persistent Urethritis

This is a difficulty ridding your body of the infection after one to three months of treatment. If your course of treatment doesn't work, return to your doctor for advice and information. The sooner you seek treatment the less likely you are to experience persistent urethritis.

Reactive arthritis

This is when your immune system attacks your joints rather than the bacteria. It causes joint pain and conjunctivitis. There is no cure but it usually disappears after six months.

Epididymo-orchitis

This is a complication found in men who do not seek treatment for non-specific urethritis. It's a combination of epididymitis, the inflammation of the tubes that transport sperm, and orchitis, inflammation of the testicles.

In women untreated non-specific urethritis can lead to pelvic inflammatory disease (PID). In turn, PID can lead to infertility and ectopic pregnancy.

Once you have treated non-specific urethritis your sexual confidence will return and you can relax back into enjoying your sex life. Taking a course of antibiotics to cure non-specific urethritis will quickly rid you of an infection and put your mind at rest.

How is non-specific urethritis caught?

Through vaginal, anal and oral sex, sensitivity to creams and lotions, friction to the urethra, and thrush or cystitis. It's very common. There are lots of ways to contract and spread non-specific urethritis. It is not a sexually transmitted disease, but it is caught via unprotected sex.

My partner has non-specific urethritis - have they been cheating?

Not necessarily. Non-specific urethritis can be developed for a number of reasons including soap irritation. You may have non-specific urethritis yourself but not display any symptoms.

Will I have non-specific urethritis for life?

No. It's easily treated with antibiotics and clears up swiftly if you get treatment sooner rather than later. Leaving symptoms can lead to pain, distress and long-term complications.

Can I treat non-specific urethritis without telling my partner?

You can but it's not advisable. If you've had unprotected sex with your partner it's likely they have non-specific urethritis too, even if they are not displaying any symptoms. Women, in particular, tend not to have any symptoms.

If you treat yourself for non-specific urethritis you will simply be re-infected when you have sex with your partner.

Your doctor or sexual health clinic can provide treatment for non-specific urethritis. You can also buy it online after an online consultation. The treatment is simply a course of antibiotics.

If you are experiencing symptoms or understand that your partner has non-specific urethritis you will need a course of antibiotics. It is worth getting tested to make sure you do not have chlamydia or gonorrhoea, both of which have similar symptoms to non-specific urethritis. Once you know what you have contracted you can be prescribed a suitable treatment.

Herbal remedies available online or over-the-counter for non-specific urethritis are not an effective way to treat any STI or bacterial infection. It's best to obtain prescription treatment as this is the only guaranteed way to clear your infection. Using over the counter remedies will only prolong the amount of time you have the infection, increasing your risk of complications and potentially spreading it to others.

STIs are prevalent in the UK and non-specific urethritis is one of the most common. All sexually active adults are at risk of catching an STI unless they protect themselves.

To keep yourself safe you should always use a good quality condom and follow the instruction to prevent an exchange of fluids which transmits STIs.

Other ways to protect yourself are:

• Minimising your number of sexual partners
• Avoid sharing sex toys.
• Use dental dams. These are small squares of latex or silicone that are placed over the vaginal area to separate mouth from fluids
• Get yourself tested for STIs on a regular basis. If you leave STIs untreated they will multiply and potentially cause complications
• Ask your partner to have an STI screening too.
• Get any required treatment rapidly

Non-specific urethritis is a bacterial infection that's easily and quickly treated with antibiotics. There is no reason to delay your treatment.