Non specific urethritis

What is NSU?

Urethritis means an inflammation of the urethra (the passage inside the penis). The cause cannot always be identified and, thus, the condition is called Non-Specific Urethritis NSU). However, a germ called chlamydia is often the cause of this infection.NSU is usually contracted by having sex with someone who has an infection, but it CAN also develop in one partner in a steady relationship where both people have had sex ONLY with each other.

What are the symptoms?

The symptoms of NSU include a burning sensation when passing urine or a discharge from the penis or vagina, or both. However, there are NO symptoms in many cases. Therefore, it is vital that BOTH partners are checked and treated for NSU.

Treatment

NSU is easily treated with tablets. Two types are used in this clinic. One is Zithromax – 4 tablets in one go. It’s very effective, especially if chlamydia is the cause. The other is Doxycycline and needs to be taken for 2 weeks. As with all tablets, take these with plenty of water to prevent them “sticking” on the way down.

Cautions on treatment

Very rarely, a skin reaction can occur in some patients taking Doxycycline on exposure to strong sunlight. So, avoid sunbathing or UV sunbeds while taking these tablets. WARNING! These tablets are dangerous to use after the expiry date.

You and your partner

If left untreated, the germs which cause NSU can cause chronic pain in the testes in men or a pelvic infection in women, which can lead to chronic pelvic pain, block the fallopian tubes, and sterility. Therefore, both you and your partner need treatment, even if your partner does not have any symptoms. To prevent re-infection, do NOT have sex with your partner until AFTER you have both finished your treatment. In some rare case, follow-up tests are required.

What about alcohol?

A high concentration of alcohol in the urine CAN DELAY the healing of the urethra. It is wise to go easy on alcohol over the next few weeks. There is no reaction between alcohol and the tablets. So, if you take a few drinks, DO NOT stop taking the tablets as directed !

QUESTIONS PATIENTS WILL ASK

When can we have unprotected sex again?
Answer: In general, we think it takes a week for chlamydia to be eradicated from the urethra, so most clinics will say “no unprotected sex for a week after treatment”.

My girlfriend and I were both treated with 1 gram of Azithromycin at the same time, but after 4 days we had unprotected sex. Do we need re-treatment?
Answer: This is a difficult question, because the evidence is not there for a scientifically valid answer. From a common sense point of view, if a couple take 1 gram of Azithromycin at the same time, does it really matter if they have unprotected sex at any stage? We don’t know. In an effort to standardise advice in the United Kingdom, we generally say “no unprotected sex for a week”, but if a couple do have unprotected sex, it’s up to the individual physician to decide whether to re-treat both or leave it.

It’s over a month now since I had the treatment for NSU. I haven’t had unprotected sex with anybody, but I still feel occasional bouts of stinging pain. Do I need to worry?
Answer: The inflammation from urethritis can take some time to settle. Particularly, for example, if it’s due to adenovirus it can take weeks for the dysuria to spontaneously disappear. In other situations it’s worth enquiring about heavy alcohol intake as it’s well known that binge drinking can dehydrate the body sufficiently to make the patient feel like there is a urethritis the following day when passing highly concentrated urine. I explain this to young men by using the analogy of going for a pee immediately after a bath or shower. There can be initial stinging in the urethra as the urinary pH is changed from neutral pH of water, to the acidic or basic pH of the urine.

My girlfriend has been diagnosed with BV. Could that be the cause of my urethritis?
Answer: No. BV does not cause infection in men. A few would dispute this.

I had oral sex from a girl a few weeks ago. Could I have got NSU from her?
Answer: Gonorrhoea can be readily transmitted by oral sex and chlamydia can easily be found using NAAT on throat swabs. So the answer is yes, but it’s uncommon. Adenovirus, however, is readily transmitted from throat to urethra and can cause a painful urethritis.

I have just been for a pee before coming into the clinic. Will that affect these tests?
Answer: Obviously, peeing shortly before a urethral gram stain investigation can have an effect if the urethritis is subtle. One study using Aptima Combo 2 has shown that a second urine done 20 minutes later is just as good as the first urine, so for NAAT testing with Aptima Combo 2 the time of passing last urine is largely irrelevant.

I brought in a urine sample Doc’. You can see it’s all cloudy. Does that mean I’ve got NSU?
Answer: No. Cloudiness of urine is usually due to crystals and a drop of acetic acid put into the sample will instantly clear it, impressing the patient and reassuring everyone.

The clinic I was in once made me do two urine samples – a first, then a second. Is that not relevant anymore?
Answer: In very rare cases the 2 glass test can be helpful, ie. if a patient has vague symptoms and one is trying to distinguish whether it’s a cystitis or urethritis. The first catch urine will have lots of threads and debris in it, whereas the mid stream urine will be clear. It’s not needed as a routine, but there are occasions when it can be helpful.

All the tests have been negative today Doc’, even though I still feel there’s something wrong. Is there any point in me coming in first thing in the morning when I haven’t had a pee overnight?
Answer: This was considered a useful practice in bygone days when physicians were desperately trying to establish whether there really was a urethritis or not. However, the sensitivity of current NAAT testing makes this practice largely irrelevant. There are, however, occasions when it can be useful if the symptoms are vague and the history is suggestive of true urethritis, but gram stain findings don’t fit.

Doc’ – I’ve done a urine sample and I see some bits in it. Is it worth checking what they are?
Answer: Mercifully, the much loved passion for fishing for threads in old style GUM clinics has faded. It’s only on rare occasions that a thread needs to be extracted and gram stained. It can be useful in a man who has good history, good symptoms, but little or no discharge, and is absolutely refusing to have a urethral gram stain. The finding of lots of threads and a gram stain of one of the threads showing multiple pus cells would be supplementary evidence that there might be something going on.

Doc’ – I had unprotected sex a week ago. I don’t think I’ve got anything, but I’m worried. Can I have a full screen?
Answer ; Many clinics used to consider a week long enough to allow for investigations to be relevant. However, a recent consensus statement on the BASHH website states that two weeks needs to elapse before the tests can be relied upon to exclude an STD. So if a patient turns up after a week, it’s only fair to do the test then, but to emphasise to the patient that they should re-attend two weeks after the event for another screen for total reassurance.

Please remember that using a condom offers good protection against all sexually transmitted infections, including the HIV virus. Condoms are supplied free from the Family Planning Clinics and Sexual Health Clinics.