Urethritis

Also called Non-specific urethritis, NSU, Inflamed urethra

Inflammation of the urethra, usually a sexually transmitted infection. Testing at a sexual health clinic finds the cause; a GP dipstick usually does not.

What it is

Inflammation of the urethra, the tube carrying urine out of the body, causing discharge and pain on passing urine.

In men it is most often caused by a sexually transmitted infection: chlamydia, gonorrhoea, Mycoplasma genitalium or trichomonas. When no organism is identified it is called non-specific urethritis, and it is still usually treated as an infection and still requires partner notification.

The common mistake is treating it as a urinary tract infection. A urine dipstick may be misleading, the antibiotics used for cystitis do not treat chlamydia or gonorrhoea, and the partner never gets told. **A sexual health clinic is the right place**, because the tests are different and better, treatment is free, and partner notification can be done anonymously.

Mycoplasma genitalium is increasingly recognised, increasingly resistant, and needs specific testing and treatment; it is a common cause of urethritis that does not settle after standard treatment.

In women, urethritis is often part of a wider picture and the same infections should be looked for.

Untreated it can cause epididymitis in men and pelvic inflammatory disease in women, and reactive arthritis in either.

Signs you might notice

Discharge from the urethra, which may be clear, white, yellow or green.

Burning or pain on passing urine.

Itching or irritation inside the penis or the urethral opening.

Needing to pass urine more often.

Sometimes no symptoms at all, particularly with chlamydia.

Urgent: pain and swelling in a testicle, which suggests epididymitis or, in a young man with sudden severe pain, testicular torsion, which is a surgical emergency.

Also: fever, loin pain, joint pains or a red painful eye, which suggest complications.

Go to a sexual health clinic rather than assuming a urine infection.

How it can affect day-to-day life

Embarrassment sends people to the GP for a urine sample rather than to a sexual health clinic, and that route often produces the wrong test and the wrong antibiotic.

Partner notification is part of the treatment. Untreated partners cause reinfection, and clinics will contact them anonymously.

Avoiding sex until treatment is complete, for both partners, is what breaks the cycle, and the period should be confirmed with the clinic rather than guessed.

Persistent or recurrent symptoms after treatment usually mean either reinfection, Mycoplasma genitalium, or a non-infective cause, and repeated blind antibiotic courses are the wrong answer.

Some men develop persistent urethral discomfort with no infection, which behaves like a chronic pain problem and needs treating as one rather than with more antibiotics. See prostatitis.

Supporting someone well

Go to a sexual health clinic, not a GP, for discharge or pain on passing urine with any sexual risk.

Get the full range of tests, including Mycoplasma genitalium where symptoms persist.

Complete the treatment, and avoid sex for the period advised.

Make sure partners are tested and treated, or let the clinic do it anonymously.

Do not accept repeated courses of the same antibiotic for persistent symptoms; ask what else it could be.

Get testicular pain assessed urgently, and sudden severe testicular pain as an emergency.

Consider PrEP and regular screening where there is ongoing risk.

For persistent discomfort with negative tests, ask about a pain-focused approach rather than more antibiotics.

Where to get help

A sexual health clinic, free and confidential, with no referral needed.

A GP practice if a clinic is not accessible, but say clearly that a sexually transmitted cause needs excluding.

A and E for sudden severe testicular pain.

Terrence Higgins Trust and Brook for sexual health information.