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Non-Specific Urethritis

Non-specific urethritis

Introduction

Urethritis refers to inflammation of the urethra (the tube that carries urine). It is classified as non-specific when the cause of the infection remains unknown and the sexually transmitted infection gonorrhea has been ruled out as a cause. The term ‘non-specific urethritis’ (NSU) is usually used in the UK, however, elsewhere it is commonly called non-gonococcal urethritis (NGU).

NSU can only be diagnosed in men although female partners of men diagnosed with NSU may also be affected.

Causes

NSU has several causes. In some cases, the inflammation may be caused by more than one factor and the exact cause may never be identified.

One of the most common causes of NSU is the sexually transmitted infection (STI) chlamydia. NSU may also be caused by other STIs such as genital herpes and trichomonas vaginalis. Other causes may include organisms such as mycoplasma genitalium and ureaplasma urealyticum which may reside in the body without causing any symptoms but their rapid multiplication may lead to inflammation. It is understood that these organisms can also be transmitted sexually.

While NSU can be contracted or transmitted through sexual contact, it is not the only way in which one gets the disease.

The inflammation may also be caused by other bacteria that cause infection in the kidney, bladder and urethra. Kidney or bladder stones could also trigger the condition.

Damage to the urethra from friction around the area could also cause inflammation. In some cases, usage of certain liquids such as highly perfumed shower gels or medicated liquids may cause irritation. In very rare cases, irritation may be caused because of sensitive skin coming in contact with a particular ingredient in soap or because of contact with latex or some particular chemicals.

Clinical presentation

NSU can only be diagnosed in men as there are no symptoms in women. Even men with inflammation may have no or very mild symptoms initially. Symptoms may show up within a day or two or sometimes only after two to four weeks of getting infected depending on the cause. Generally, inflammation caused by STIs takes longer to develop while in non-infectious causes, the symptoms would occur sooner.

Symptoms may include a burning sensation, discomfort or pain while passing urine, the urge to urinate frequently, a white or cloudy discharge from the penis, and irritation or soreness around the tip of the penis.

If the inflammation is caused by a particular infection, there may be additional symptoms associated with the same.

In women, symptoms usually develop only if the infection spreads to other parts of the reproductive system. The spread of infection to other parts may result in a condition known as pelvic inflammatory disease or PID. Possible symptoms of PID include pain around the pelvic region and lower abdomen, pain during sexual intercourse or while passing urine, heavy and painful periods, and unusual vaginal discharge.

Diagnosis

The diagnosis typically involves a swab test. A small sample of fluid is taken from the urethra using a swab (a small cotton bud) and is examined under a microscope. It is painless but may involve slight discomfort.

A urine test may also be performed to confirm the diagnosis. Usually, both swab and urine tests are performed to arrive at the correct diagnosis.

Also, since the symptoms are similar to several other conditions, including several STIs, it is advisable to get tested for certain STIs, in particular, gonorrhea and chlamydia. A practitioner may also advise testing for HIV and other common STIs.

Treatment

Treatment with antibiotics is usually prescribed for NSU. The most common antibiotics prescribed for treatment are azithromycin and doxycycline. Often, even if no infection is identified but there is inflammation, an antibiotic course is prescribed for treatment. The dosage could vary, from a large single dose to a longer dose of up to two weeks. There may be some side effects associated with the antibiotics, such as, vomiting and diarrhea.

Some men report recurring instances of NSU, in which case a second course of antibiotics may be required.

Depending on the cause, the symptoms may disappear entirely within two or three weeks or even earlier. Usually, there is no need for a follow-up if the dosage has been taken correctly. Patients are advised not to have sexual intercourse (vaginal, anal or oral) until they have finished the course and their symptoms have disappeared.

Additionally, it is important for all recent sexual partners of a patient to also be treated. Even though NSU may have been caused by a non-infectious cause, it is possible to pass it on through sexual contact. For this reason, NSU is treated like an STI.

Complications

In some cases, even after treatment through antibiotics, urethritis may be persistent and recurrent.

A rare complication of NSU is reactive arthritis, in which the immune system begins attacking healthy tissue instead of the bacteria responsible for NSU. Reactive arthritis may cause joint pain and conjunctivitis, but this is a very rare occurrence. Another possible complication is epididymo-orchitis which is inflammation of the epididymis (the tube in testicles that stores sperm). In women, NSU may lead to pelvic inflammatory disease or PID if left untreated.

Prevention

Since the most common cases of NSU are STIs, safe sexual practices can help reduce the risk of contracting and transmitting it.