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Non Specific Urethritis

Non Specific Urethritis (NSU) occurs only in men and refers to inflammation of the urethra (the tube that you pass urine from) that is not caused by infection with Chlamydia or Gonorrhoea. It can be caused by infection or irritation from spermicidal creams, soaps and deodorants.

Infective causes include the bacteria, Mycoplasma genitalium and Ureaplasma urealyticum, as well as other organisms such as Trichomonas vaginalis and Candida. Herpes infection can also lead to NSU.

The Illness

NSU may cause discharge from the penis or irritation of the penis. Sometimes, there is also discomfort on passing urine or increased need to pass urine. Female contacts usually have no symptoms but potentially are at risk from pelvic inflammatory disease if untreated.

In a male under the age of 35, with urinary symptoms the commonest cause is a sexually transmitted infection. A normal urine culture will often be negative, so specific specialised STD tests are required. Our symptomatic screen include specific  PCR( DNA ) tests covering the common causes and a urethral culture swab to detect evidence of inflammation within the urethra and to rule out gonorrhoea. It is also important to have a culture swab , given the increasing antibiotic resistance of Gonorrhoea infections.

Diagnosis of NSU

The organism involved can be found by PCR testing on a swab from the tip of the penis or on urine sample.

Contact Tracing

Current and recent sexual partners (last 12 weeks) should be advised to have testing and provided with empirical antibiotic therapy. You should avoid having sex again (even protected) for a minimum of one week after completing the antibiotic course.

If symptoms continue despite treatment, we term this refractory or persistent NSU. Recommended treatments include:

  • Azithromycin 500 mg day one. Followed by 250mg each day for 4 days in combination with Metronidazole 400mg for 5 days. The aim of this combination is to provide cover for both Mycoplasma Genitalium and Trichomonas Vaginalis.

Complications of NSU

  • Testicular inflammation and potential impact on fertility
  • Reactive arthritis (which results secondary to the STI infection, causing the immune to act against your bodies joints)
  • Prostatitus (inflammation of the prostate)

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