Urethritis (NSU) in gay / bisexual men
What is urethritis (NSU)?
- Urethritis is an inflammatory condition in the urethra (urine passage) of men.
- It is commonly caused by a sexually transmitted infection – either chlamydia or gonorrhoea.
- In men with urethritis where chlamydia and gonorrhoea have been excluded as a cause the condition is called Non Specific Urethritis (NSU).
- NSU usually causes a discharge from the tip if the penis, pain on passing urine or irritation in the urethra.
- It may be caused by multiple factors including sexually transmitted infections (STIs) such as Mycoplasma genitalium, other non sexually transmitted infections and irritants.
- NSU can be caught through sex – but not always.
- It is treated with antibiotics.
- If you have NSU we recommend that you should have a full STI screen including an HIV test.
How common is NSU?
- It is the most common STI diagnosed in gay and bisexual men.
- It occurs more frequently in men with a new sexual partner.
How do you catch NSU?
- NSU is usually caught through unprotected sex:
- Oral sex
- Anal sex
- Vaginal sex
- Other infections that are not sexually transmitted may very occasionally lead to NSU:
- Urinary infection, adenovirus – often with conjunctivitis
- Substances that irritate the delicate lining of the urethra can lead to NSU:
- Shower gels, tea tree oil, antiseptics or disinfectants
- Trauma to the urethra can lead to NSU:
- Vigorous and frequent sex, masturbation, inspecting and squeezing the tip of the penis
- NSU cannot be caught by kissing, from swimming pools, saunas or toilet seats.
What would I notice if I had NSU?
- Most men would usually notice one or more of the following symptoms:
- A milky or clear discharge from the tip of the penis
- Pain on passing urine
- A feeling of wanting to pass urine frequently
- Itching or irritation inside the urethra or tip of the penis
- Some men have only very mild symptoms or have no symptoms at all.
How do I get tested for NSU?
- A swab taken from the tip of the penis is spread on a glass slide, stained and examined under the microscope for signs of infection. This test can only be done at a specialised sexual health clinic. The result is available immediately. This test will also detect gonorrhoea in most men.
- You must not have passed urine for at least 2 hours prior to the test,
- Other tests (swab from penis and urine test) are taken to check for chlamydia and gonorrhoea.
- These results will be ready in 3 days. They will be sent to you via a text message or the nurse may call you.
How is NSU treated?
- Treatment with antibiotics is given immediately to cover both NSU and Chlamydia.
o a single dose of azithromycin 1g (4 tablets)
o a week of doxycycline capsules 100mg twice daily
- All treatments from the Wolverton Centre are free and are given to you in the clinic
- Both treatments are highly effective – but you need to wait 7 days before having sex again to give the azithromycin time to work.
- We don’t normally need to do another test to check the NSU has gone, as long as you have taken your treatment correctly and your symptoms have improved.
What about my partner?
- NSU is usually a sexually transmitted infection so it is important that all current sexual partners and others within the last 4 weeks are tested and treated (even if their tests are negative) before resuming sex again.
What problems can untreated NSU lead to?
- NSU doesn’t usually cause any problems.
- Very rarely it may lead to:
- epididymo- orchitis (pain in the testicles)
- reactive arthritis (a type of arthritis) which may also be associated with conjunctivitis – this is called Reiter’s Syndrome
Will NSU come back again after treatment?
- In10 to 20% men with NSU their symptoms may persist or recur again after treatment.
- If this happens a second course of antibiotics will be given.
- Very rarely symptoms may persist despite this – they usually settle with time. You may be referred to one of the consultant’s specialist clinics to help with this.