Non-specific urethritis (NSU)

What is urethritis?

Urethritis affects mainly men and means inflammation of the urethra (the urine and semen passage). The urethra can be affected by various sexually transmitted infections (STIs). The most common causes are infection with gonorrhoea and chlamydia, however, other bacteria or viruses may be involved.

If tests for gonorrhoea and chlamydia are negative, then the urethritis is usually called non-specific urethritis (or NSU for short).

How do you get infected?

Urethritis can be transmitted in most cases by having vaginal, anal or oral sex without a condom.

What are the symptoms?

• discharge (pus or fluid) from the urethra
• pain or discomfort when passing urine
• an uncomfortable feeling in the urethra.

What should I do if I think I have urethritis?

The best way to find out if you have urethritis is to have a sexual health check. The diagnosis of urethritis is usually only made in men with symptoms or men who are a sexual contact of someone with gonorrhoea or chlamydia.

Tests are best done when you have not passed urine for at least two hours. A small swab is inserted into the tip of the penis to obtain a sample of fluid - this is then examined under a microscope to check for signs of inflammation. At the same time the doctor or nurse will also do specific tests for gonorrhoea and chlamydia.

How is urethritis treated?

If the doctor or nurse confirms you have urethritis or NSU from the microscope test, you will be given antibiotics. This may either be a course of tablets over several days or a single dose - your doctor will advise what is best for you. The commonest cause of urethritis is chlamydia, so sexual partners also need testing and treatment. Even if your STI check is negative it is still advisable that your sexual partner(s) get treatment as current tests can occasionally miss chlamydia even when it is the cause of the urethritis or NSU. If there are signs of gonorrhoea at the time of the examination then treatment will also be given for this.

How do I know if my partner(s) need treatment?

If you have had sex without a condom (including oral sex) with your sexual partner(s) it is likely they are also infected with whatever is causing the urethritis/NSU. It is important they have a sexual health check and treatment for STIs even if they have no symptoms. It is usually recommended that all sexual contacts within the previous two months are tested and treated.

What should I do if I have urethritis/NSU?

• finish all the antibiotics, even if symptoms resolve in a few days, as the infection may still be there
• don't have sex or use a condom every time you have sex until seven days after single-dose treatment, or until all tablets from a course of treatment have been taken. This will prevent you from passing the infection onto others and will also prevent you from being reinfected 
• you should not have sexual intercourse without a condom until your partner(s) have been treated
• if symptoms remain after two weeks or if they come back, you may need further tests and treatment so contact your doctor or sexual health clinic for this
• do not keep squeezing the penis to check for discharge as it may worsen the problem.

Is urethritis likely to recur after treatment?

Urethritis can very occasionally not get better or come back after the antibiotics have been taken. After treatment some men may continue to experience mild urethral discomfort that will usually get better within two weeks of treatment. If the symptoms persist for longer than two weeks or get worse again after treatment has ended, you should go back to your doctor or sexual health clinic. Further tests and treatment are sometimes needed.

Sometimes men experience urethral irritation when no inflammation or infection is present. This condition is called urethral irritation. It is not caused by infection and the symptoms are usually short-lived.

Possible causes of irritation:

• frequent squeezing of the penis
• topical irritants (eg. soap, shampoo) 
• frequent or vigorous sex or masturbation 
• allergy (eg. to spermicide) 
• general illness
• concentrated urine from dehydration 
• alcohol, caffeine and some medications.

Urethral irritation is not an STI and does not require antibiotic treatment. Symptoms should resolve quickly if you avoid the cause of the irritation, ie. avoid soaps, squeezing of the penis.

Original material provided by Auckland Sexual Health Service. Reviewed by everybody in May 2008.