Non-specific urethritis (NSU)

Causes of NSU

There isn't one specific cause of NSU. It's usually the result of vaginal, oral or anal sex with a partner who has a sexually transmitted infection. It's called 'non specific' because with further testing a variety of infections may be identified as being responsible for the symptoms.

Sexually transmitted infections, such as chlamydia, herpes and trichomonas vaginalis, can cause urethritis. Other organisms such as mycoplasma gentialium and ureaplasma urealyticum and other bacterial infections can cause urethritis.

Sometimes inflammation to the urethra can be caused by friction (vigorous sex or masturbation) or by inserting objects, applying liquids and chemicals into the urethra.

It isn't easy to diagnose NSU in women. This information only discusses NSU in men.

How NSU is transmitted

During unprotected vaginal, anal or oral sex, organisms that cause inflammation can pass into the urethra.

You can't get NSU from kissing, hugging, sharing baths or towels or from toilet seats, sharing plates, cups or cutlery.

Symptoms of NSU

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 two to four weeks of contact with an infection. Sometimes much sooner.

Signs and symptoms include:

• white or cloudy discharge from the penis, usually more noticeable first thing in the morning
• pain, burning sensation or difficulty when passing urine
• feeling of needing to pass water frequently
• itching or irritation at the end of the urethra

Testing for NSU

If you have any signs or symptoms you should have a check up. Testing is free on the NHS from general practice, genitourinary medicine (GUM) clinics or a sexual health clinic.

The tests may involve using a swab (this looks like a cotton bud) to take a sample of cells from the urethra or having a urine test. Your urethra will also be examined carefully. Most men are advised not to urinate for at least two hours before the test, so it can be as accurate as possible.

Treatments for NSU

NSU is treated with antibiotics given either as a single dose or a longer course of tablets. NSU can recur.

To avoid reinfection, any sexual partners should be treated too. If left untreated, some causes of NSU can have long-term consequences. These include:

• painful infection in the testicles
• possible reduced fertility
• inflammation of the joints (sometimes reactive arthritis is accompanied by inflammation of the eyes as well as the urethra; this is known as Reiter’s syndrome)
• pelvic inflammatory disease in a female sexual partner

Advice and support

You can go to your general practice, a GUM clinic or a sexual health clinic.

You can call the FPA helpline on 0845 122 8690, or the NHS Sexual Health Helpline on 0800 567123.

How to avoid STIs

• Male and female condoms, when used correctly, can help protect against STIs.
• Before you have sex, talk to your partner about using condoms.
• Use condoms every time you have vaginal or anal sex.
• If you have oral sex, use a dam.