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Even if the infection has been contracted without sexual intercourse, nongonococcal urethritis can be spread in this way, so it’s important to take care of not just overall health but especially sexual health.

Often, the desire to rely on the most common diagnosis for an ailment leads to little knowledge regarding other possible problems. For example, the symptoms of nongonococcal urethritis often appear as a simple urinary tract infection. However, the two are quite different, with a UTI sometimes causing nongonococcal urethritis, also referred to as NGU. Understanding how this disease is contracted, what symptoms are experienced, and how it is diagnosed and treated could assist patients in knowing what to expect.

What is Nongonococcal Urethritis?

NGU is an infection that occurs in the urethra that is caused by pathogens, or germs, especially bacteria. However, this particular ailment omits gonorrhea as a cause. Some of the pathogens identified as developing into nongonococcal urethritis include:

  • Adenovirus
  • Chlamydia trachomatis
  • Herpes simplex virus
  • Mycoplasm genitalium

Within these, Chlamydia, which is a common infection found in both men and women, is the biggest culprit, though others also exist.

Symptoms of NGU

Nongonococcal urethritis can infect multiple parts of the body, and symptoms vary based on the location. If the infection is anal, rectal itching and discharge, as well as pain when defecating, are the most common symptoms. If the infection is oral, it’s likely there are no notable symptoms, though in some cases, patients experience a sore throat. More commonly, the infection is urethral (and can also be vaginal for women) and lead to several symptoms, such as:

  • Discharge from the penis or vagina
  • Pain and burning when urinating
  • Itching or general irritation and tenderness of the genitals
  • Underwear stains (typically from discharge and more common in men)
  • Abdominal pain (more likely in women)
  • Abnormal vaginal bleeding in women

Transmission of Nongonococcal Urethritis

In some ways, nongonococcal urethritis is categorized as an STI (sexually transmitted infection). That’s because one of the easiest ways to pass the pathogens between individuals is through sex, whether vaginal, anal, or oral. Bodily fluids do not need to be exchanged to contract the disease. Only the contact between mucus membranes with an infected individual is required to contract the infection.

However, sex is not the only way to contract NGU. Other methods of contamination include:

  • Developing a urinary tract infection
  • Having an inflamed prostate gland due to the presence of bacteria
  • Narrowing of closing of the urethral structure (mainly occurring in the penis)
  • Catheterization
  • Foreskin tightening that doesn’t allow it to be pulled back from the head of the penis
  • Exposure during birth via eyes (causing conjunctivitis), ears, or lungs (causing pneumonia)

Complications due to NGU

Determining the existence of nongonococcal urethritis is crucial to avoid a number of complications. If left untreated, the germs that lead to the development of NGU – especially chlamydia – can cause other problems for both men and women.

Men may suffer:

  • Inflammation of the cordlike structure along the posterior border of the testes, or the epididymis, which can cause infertility if not treated
  • A form of arthritis known as Reiter’s syndrome
  • Conjunctivitis, or infection and inflammation in the eyes
  • Skin lesions that could become infected and lead to staff infection
  • Discharge from the penis

For women, consequences can include:

  • PID, or pelvic inflammatory disease, which can later lead to ectopic or tubal pregnancies
  • Urethritis
  • Chronic pain in the pelvis
  • MPC, or mucopurulent cervicitis, or an infected and inflamed cervix
  • Vaginitis
  • Miscarriage (early term, most commonly)
In anyone suffering from NGU contracted anally, there could be issues with proctitis, or an inflamed rectum. Infants who contract NGU during birth often experience conjunctivitis, which can cause blindness if not treated, and pneumonia, which can be deadly due to the fact that the lungs are newly developed, and the immune system is still underdeveloped.

NGU: Diagnosis and treatment

When men present with urethritis, a physician will take a culture to test for gonorrhea (to rule out this possible cause) and possibly for chlamydia as the most common cause to determine a diagnosis of nongonococcal urethritis. For women, the culture for chlamydia is the most common test to diagnose the disease.

Treatment involves several steps. First, an antibiotic will be prescribed, such as azithromycin or doxycycline, with an alternative possibility of ofloxacin. For recurrent and persistent urethritis, more aggressive antibiotics will likely be used, such as metronidazole or erythromycin. The full course of medication should be completed to assure maximum effect. Stopping medication early can lead to continued and worsening infection, as well as recurrent symptoms.
Once diagnosed, it is important to inform any and all sexual partners so that they, too, may be tested and treated. While there are other ways to develop the disease, sexual contact is the most common means, and it is highly contagious. It’s important to abstain from any sexual contact with any and all partners until everyone has completed treatment.

Upon finishing the antibiotics, all symptoms should have disappeared. If they persist, or if they return, it’s crucial to return to the physician for continued evaluation. There may be a reason as yet unknown that keeps the infection from going away.

Reducing the risk of NGU

One of the best ways to stay healthy is to avoid the risk of contracting nongonococcal urethritis. There are several ways to do this, including:

  • Abstaining from sex and, when sexually active, practicing mutual monogamy with an uninfected partner
  • Using a latex condom during all types of sex, including vaginal, anal, and oral, from beginning to end
  • Getting regular check ups when sexually active
  • Abstaining from sex if any or all partners have an STD, until the STD has been treated and cleared
  • Communication between partners who are sexually involved
  • Receiving prompt attention and treatment for infections to avoid spreading or having a recurring infection


Even if the infection has been contracted without sexual intercourse, nongonococcal urethritis can be spread in this way, so it’s important to take care of not just overall health but especially sexual health. Knowing what experiences your partner or partners have had, as well as practicing safe sex to avoid contraction of any STI, is crucial to maintaining health and wellness. With GNU, there are enough complications that it is in a patient’s best interest to work with a physician and inform all partners so that care can be taken to stop the cycle.

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