Urethral Inflammation Requiring Investigation
NGU causes urethral symptoms similar to gonorrhoea but has different causes including chlamydia and mycoplasma. Proper diagnosis identifies the underlying cause and guides effective treatment.
Non-gonococcal urethritis (NGU) is inflammation of the urethra (the tube carrying urine out of the body) not caused by gonorrhoea. It's diagnosed when urethritis is present but gonorrhoea tests are negative. Chlamydia is the most common cause, followed by Mycoplasma genitalium, but many cases have no identified pathogen. NGU is common in sexually active men.
NGU is diagnosed when you have urethritis symptoms or signs (discharge, increased white blood cells in urethral sample) but test negative for gonorrhoea. We test for specific causes including chlamydia and M. genitalium. A urine sample and/or urethral swab is needed. Rectal and throat samples may also be taken depending on sexual history.
Treatment depends on the identified cause. For chlamydia-positive NGU, doxycycline for 7 days is standard. For M. genitalium, resistance-guided treatment is needed. When no pathogen is found, empirical treatment with doxycycline is given. Partners should be tested and treated. Test of cure is recommended, especially for M. genitalium.
Both cause urethritis with similar symptoms. Gonorrhoea is caused by Neisseria gonorrhoeae and typically causes more profuse, purulent discharge. NGU is caused by other organisms (usually chlamydia or mycoplasma) and often has milder symptoms. They're distinguished by testing - we test for both.
Yes. Even when no specific pathogen is identified (which happens in 20-30% of cases), treatment is recommended if you have symptoms or signs of urethritis. Doxycycline is effective against most causes. If symptoms persist after treatment, further investigation including M. gen testing is needed.
Recurrent NGU can be due to: reinfection from an untreated partner, infection with a resistant organism (especially M. genitalium), unidentified pathogen, or non-infectious causes. Persistent cases need comprehensive testing including M. genitalium with resistance testing. Partners must be treated simultaneously.
Yes, female partners should be tested and treated for chlamydia and possibly other pathogens depending on findings. Untreated infection in women can cause cervicitis and PID, affecting fertility. Both partners should avoid sex until treatment is complete to prevent ping-pong reinfection.
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