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Urethritis (NSU) in heterosexual 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 a common condition in sexually active men.
  • It occurs more frequently in men with a new sexual partner.

How do you catch NSU?

  • NSU is usually caught through unprotected sex:
    • Vaginal sex
    • Oral sex
    • Anal 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.


  • a single dose of azithromycin 1g (4 tablets)


  • 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.

For more information