Nongonococcal Urethritis: Causes, Symptoms, and Treatment

Symptoms of sexually transmitted infections (STIs), such as pain or a burning sensation while urinating can be concerning.

Though there are several possible causes of painful or burning urination, if accompanied by itchy skin and discharge, you may have nongonococcal urethritis (NGU). 

Anyone who’s sexually active can get nongonococcal urethritis.

It is also the most common sexually transmitted infection in people with penises. 

In this article, we’ll go over the symptoms, causes, and diagnosis of NGU, as well as how it’s commonly transmitted.

We’ll also cover the possible complications that can happen if NGU is left untreated and where and how you can find treatment.

Finally, we’ll explain what you can do to prevent NGU and when you may want to reach out to a healthcare provider for care.

What is Nongonococcal Urethritis?

Nongonococcal urethritis (NGU) is an infection of the urethra, the tube that allows urine to be passed out of the body.

In people born with penises, the urethra also carries semen.

In people born with vaginas, the urethra is very short and sits just above the vagina. 

Dissecting the name of NGU also helps to understand the condition it describes –  “Urethritis” refers to inflammation and infection of the urethra, while “nongonococcal” refers to an infection caused by an agent other than gonorrhea.

The most common cause of NGU is chlamydia. In fact, 15-40% of NGU cases are caused by chlamydia.

However, the infection can also be caused by other agents, including: 

• Mycoplasma genitalium (M. genitalium)
• Trichomonas vaginalis
• Herpes simplex virus
• Epstein-Barr virus
• Adenovirus

Though cases of NGU caused by Trichomonas vaginalis, herpes simplex virus, Epstein-Barr virus, and Adenovirus are rare, M. genitalium accounts for roughly 15-20% of NGU cases.

Symptoms

Importantly, not all people who get NGU experience symptoms, which can make it challenging to diagnose. In fact, data from 2009 suggests that over 40% of all cases of NGU are asymptomatic. 

When symptoms are present, they can take between one to five weeks to appear after infection.

These symptoms can include:

• Pain or burning sensation during urination
• Itchy skin
• Penile burning (in people born with penises)
• Urethral discharge (discharge can contain pus, mucus, or appear watery) 

People born with penises may experience additional symptoms, such as:

• Fever
• Testicular pain
• Testicular swelling
• Sore throat
• Rectal pain
• Rectal discharge

Though less common, NGU can also present with:

• Reactive arthritis
• Pink eye (conjunctivitis)

Diagnosis

Diagnosing NGU requires the exclusion of gonorrheal infection.

To rule out a gonorrheal infection, your provider will perform a gram stain on your discharge to look for gram-negative diplococci or test your urine.

If diplococci are present, then a gonorrheal infection is confirmed. If not, the diagnosis is classified as NGU. 

Your provider may also physically examine your discharge to aid their diagnosis, as NGU discharge is usually mucus-like or clear, while a gonorrheal infection usually produces a discharge that contains pus.

However, because these generalizations aren’t reliable, testing can help to confirm the diagnosis.

Transmission

NGU is almost exclusively spread through sexual contact, including that which takes place during oral, anal, and vaginal sex.

A person infected with NGU can spread the infection from the time they are infected until they are cured.

Though less common, NGU can also be spread during birth or as a result of urinary tract infections, bacterial prostatitis, urethral stricture, tightening of the foreskin of the penis, and catheterization.

Treatment for Nongonococcal Urethritis

NGU is treated with antibiotics.

The recommended treatment regimen for NGU consists of either:

• A single dose of 1 g of azithromycin taken orally

OR

• 100 mg of doxycycline taken orally twice a day for seven days 

Both azithromycin and doxycycline are effective for treating NGU caused by chlamydia.

However, NGU associated with M. genitalium responds better to azithromycin.

What happens if untreated?

When left untreated, NGU can lead to complications. 

Complications in people born with penises:

• Epididymitis
• Prostatitis
• Abscess formation
• Reactive arthritis
• Pink eye (conjunctivitis)

Complications in people born with vaginas:

• Pelvic inflammatory disease (PID)
• Infertility
• Ectopic pregnancy
• Miscarriage
• Vaginitis
• Mucopurulent cervicitis (MPC)
• Chronic pelvic pain

Complications in children born to mothers with NGU caused by chlamydia:

• Pink eye (conjunctivitis)
• Iritis
• Pneumonia

Non-gender specific complications:

• Inflamed rectum (in cases of NGU that is spread through anal sex)
• Lymphogranuloma venereum, a genital ulcer disease (in cases of NGU caused by chlamydia)

Generally, complications in people born with penises are rare, while complications in people born with vaginas occur in 10-40% of cases. 

How to get treatment

Most healthcare providers offer treatment for NGU, including providers at K Health. To seek treatment, make an appointment with a healthcare provider to discuss your symptoms and confirm diagnosis.

Preventing the Spread of Nongonococcal Urethritis

Thankfully, there are a number of things you can do to help prevent getting and spreading NGU, including:

• Limiting your number of sex partners
• Use a condom when having anal, oral, and vaginal sex
• Wash your hands thoroughly after sexual activity
• Get regularly tested (particularly for each new partner or symptom)

Seeking Medical Attention

If you experience any of the symptoms of NGU, particularly a painful or burning sensation during urination and/or urethral discharge, it’s important to speak to your healthcare provider to get a proper diagnosis and treatment.

How K Health Can Help

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