Non-Gonococcal Urethritis (NGU)

NGU (Non-Gonococcal Urethritis) is an infection of the urethra caused by pathogens (germs) other than gonorrhea.

Several types of germs cause NGU, the most common and serious is chlamydia. Chlamydia is very common in both males and females. The diagnosis of NGU is more commonly made in males than in females, mainly due to the anatomical differences. Germs that can cause NGU include but are not limited to:

• Chlamydia trachomatis (most common)
• Ureaplasma urealyticum
• Trichomonas vaginalis (rare)
• Herpes simplex virus (rare)
• Haemophilus vaginalis
• Mycoplasma genitalium

Sexually: Most germs that cause NGU can be passed during sex (vaginal, anal or oral) that involves direct mucous membrane contact with an infected person.

Nonsexual: These causes of NGU may include: urinary tract infections, an inflamed prostate gland due to bacteria (bacterial prostatitis), a narrowing or closing of the tube in the penis (urethral stricture), a tightening of the foreskin so that it cannot be pulled back from the head of the penis (phimosa), the result of a process such as inserting a tube into the penis (catheterization).

Perinatal: During birth, infants may be exposed to the germs causing NGU in passage through the birth canal. This may cause the baby to have infections in the eyes (conjunctivitis), ears and lungs (pneumonia).

In men, urethral infection, symptoms may include the following:

• Discharge from the penis
• Burning or pain when urinating
• Itching, irritation or tenderness
• Underwear stain

Symptoms of NGU in women can include:

• Discharge from the vagina
• Burning or pain when urinating
• Abdominal pain or abnormal vaginal bleeding may be an indication that the infection has progressed to pelvic inflammatory disease (PID)

Anal or oral infections may occur in both men and women. Anal infections may result in rectal itching, discharge or pain during a bowel movement. Oral infections may occur but most (90 percent) of these infections are asymptomatic. Some people might have a sore throat.

An NGU diagnosis is made when a person has urethritis (inflammation of the urethra), but gonorrhea is ruled out because they have a negative test result.

• Practice abstinence. Not having sex is the best protection against acquiring NGU and other Sexually Transmitted Diseases (STD).
• Use latex condoms, consistently and correctly, from start to finish every time you have sexual intercourse.
• Have sex with only one uninfected partner who only has sex with you (mutual monogamy).
• Have regular checkups if you are sexually active.
• If you have an STD, don't have sex (oral, vaginal, anal) until all partners have been treated.
• Seek prompt, qualified and appropriate medical intervention, treatment and follow-up to break the disease cycle.
• Know your partner(s). Careful consideration and open communication between partners may protect all partners involved from infection.

The main treatments for NGU are the antibiotics azithromycin and doxycycline. Alternative antibiotics are erythromycin and ofloxacin. A woman who is pregnant, or thinks she might be, should tell her doctor. This will ensure that a medicine will be used that will not harm the baby. Take all medications, even if you start to feel better before you finish the bottle. Inform all partners. Abstain from sex until all partners are treated. Return for evaluation by a health care provider if symptoms persist or if symptoms recur after taking all the prescribed medicine.

Left untreated, the germs that cause NGU, especially chlamydia, can lead to serious complications.
For men, complications may include:

• Epididymitis (inflammation of the epididymis, the elongated, cordlike structure along the posterior border of the testes) which can lead to infertility if left untreated.
• Reiter's syndrome (arthritis)
• Conjunctivitis
• Skin lesions
• Discharge

In women:

• Pelvic Inflammatory Disease (PID) which can result in ectopic (tubal) pregnancy.
• Recurrent PID which may lead to infertility.
• Chronic pelvic pain
• Urethritis
• Vaginitis
• Mucopurulent cervicitis (MPC)
• Spontaneous abortion (miscarriage)

For men or women, infections caused by anal sex may lead to severe proctitis (inflamed rectum).
Infants exposed to the germs causing NGU during passage through the birth canal may develop conjunctivitis (eye infection) and/or pneumonia.

Yes. If you have been told that you have NGU, talk to your partner(s), and let them know so they can be tested and treated. The most common cause of NGU is chlamydia, and it is easy to pass from an infected partner to one who is not infected. A man who is diagnosed with NGU should tell his female sex partner(s) and ask her to get tested. He can prevent serious damage to her body by telling her right away. All sex partners of someone diagnosed with NGU should be treated because:

• They may have an infection and not know it.
• It keeps them from passing the infection to others.
• It prevents them from suffering possible medical complications.

Remember: Do not have sex until your partner(s) have been tested and treated.

If you are sexually active with more than one person and do not use latex condoms, then you should talk to your health care provider about being tested for STDs and NGU. Not all STDs cause symptoms, and you may have one and not know it.

• Illinois Department of Public Health
  IDPH HIV/STD Hotline 800-243-2437 (TTY 800-782-0423)
• U.S. Centers for Disease Control and Prevention (CDC) 
  www.cdc.gov/std/ 
  CDC-INFO Hotline (7am-7pm Mon.-Fri. Closed Holidays)
  STD information and referrals to STD Clinics 
  800-CDC-INFO (800-232-4636) 
  TTY: 888-232-6348 
  In English, en Español
• CDC National Prevention Information Network (NPIN) 
  P.O. Box 6003 
  Rockville, MD 20849-6003 
  800-458-5231 
  888-282-7681 Fax 
  E-mail: info@cdcnpin.org
• American Social Health Association (ASHA) 
  P. O. Box 13827 
  Research Triangle Park, NC 27709-3827 
  919-361-8400