Nongonococcal Urethritis (NGU)

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Menstuff® has compiled information on the issue of Nongonococcal Urethritis.

What is NGU?
How common is NGU?
How can I get NGU?
What are the signs or symptoms of NGU?
How can I find out if I have NGU?
What can I do to reduce my risk of getting NGU?
What is the treatment for NGU?
Why worry about NGU?
Do I need to talk to my partner about NGU?
Should I talk to my health care provider about NGU?
Where can I get more information?
Resources
Related issues: Talking With Kids About Tough Issues AIDS, Bacterial Vaginosis, Blue Balls, Chancroid, Chlamydia, Condoms, Contraception, Crabs, Genital Herpes, Genital Warts, Gonorrhea, Hepatitis A, B, C, D, E, Impotency, Nongonococcal Urethritis, Pelvic Inflammatory Disease, Reproduction, STDS, Syphilis, Trichomoniasis, Yeast Infection

What is NGU?

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

How common is NGU?

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)
• Adenovirus
• Haemophilus vaginalis
• Mycoplasm genitalium

How can I get NGU?

• Sexual:

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

  These germs can be passed even if the penis or tongue does not go all the way into the vagina, mouth or rectum, and even if body fluids are not exchanged.

• 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 maybe 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

  lungs (pneumonia)

What are the signs or symptoms of NGU?

• Men (urethral infection):

  Discharge from the penis

  Burning or pain when urinating (peeing)

  Itching, irritation, or tenderness

  Underwear stain

• Women (vaginal/urethral infection): The germs that cause NGU in men might cause other infections in women. These might include vaginitis or mucopurulent cervicitis (MPC). Women may also be asymptomatic (have no symptoms). Symptoms of NGU in women can include:

  Discharge from the vagina

  Burning or pain when urinating (peeing)

  Abdominal pain or abnormal vaginal bleeding may be an indication that the infection has progressed to Pelvic inflammatory Disease (PID)

  Anal or Oral Infections

  Anal infection may result in:

  - Rectal itching

  - Discharge or pain on defecation

  Oral infection may occur. Most (90 percent) are asymptomatic, but some people might have a sore throat.

How can I find out if I have NGU?

An NGU diagnosis is made when a man has urethritis (inflammation of the urethra), but gonorrhea is ruled out because he has a negative gonorrhea culture and/or gram stain.

Other tests include:

• Chlamydia culture
• Urinalysis (sometimes, but rarely)

Women:

• Chlamydia culture
• Gonorrhea culture to rule out gonorrhea

What can I do to reduce my risk of getting NGU?

• Abstinence from sex is the best form of prevention.
• Using latex condoms from start to finish every time you have oral, vaginal or anal sex.
• Having sex with only one uninfected partner whom only has sex with you (mutual monogamy).
• Water-based spermicides can be used during vaginal sex.
• Have regular check-ups if you are sexually active.
• If you have an STD, don't have sex (oral, vaginal, anal) until all partners have been treated.
• Prompt, qualified and appropriate medical intervention, treatment and follow-up are important steps in breaking the disease cycle.
• Know your partner(s). Careful consideration and open communication between partners may protect all partners involved from infection.

What is the treatment for NGU?

The main treatments for NGU are:

• Azithromycin
• Doxycycline

Alternatives are:

• Erythromycin
• Ofloxacin

Recommended treatment for recurrent/persistent urethritis:

• Metronidazole with Erythromycin

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.

Follow-up:

• Take all medications-even if you start to feel better before you finish the bottle.
• Treat all partners.
• 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.

Why worry about NGU?

Left untreated, the germs that cause NGU-especially chlamydia-can lead to:

Men:

• 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

Women:

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

Exposure to the germs causing NGU during passage through the birth canal may result in infants having:

• Conjunctivitis (If left untreated, this may lead to blindness.)
• Pneumonia 

Do I need to talk to my partner about NGU?

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 and ask her to get tested. He can prevent lasting 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 back to you or to others.
• It prevents them from suffering possible complications.

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

Should I talk to my health care provider about NGU?

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.

Where can I get more information?

If you have additional questions about NGU, call the National STD and AIDS Hotlines at 1-800-342-2437 or 1-800-227-8922. The hotlines are open 24 hours a day, seven days a week. For information in Spanish call 1-800-344-7432, 8:00 a.m. to 2:00 a.m. Eastern Time, seven days a week. For the Deaf and Hard-of-Hearing call 1-800-243-7889, 10:00 a.m. to 10:00 p.m. Eastern Time, Monday through Friday. The hotlines provide referrals and more answers to your questions. www.ashastd.org/stdfaqs/ngu.html

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