Non-Gonococcal Urethritis (NGU): Symptoms, Causes and Treatment in the UK

Non-gonococcal urethritis, commonly referred to as NGU, is an inflammation of the urethra—the tube that carries urine from the bladder out of the body. While urethritis can be caused by the sexually transmitted infection (STI) gonorrhoea, NGU specifically refers to cases where gonorrhoea is not the cause.

In the UK, NGU is one of the most common reasons men visit sexual health clinics. It is often caused by other infections, such as Chlamydia trachomatis, or non-infectious factors like irritation. Because the symptoms of NGU and gonorrhoea are often identical, accurate testing is essential to ensure the correct antibiotic treatment is prescribed according to NICE guidelines.

Recognising the Signs

Symptoms of NGU typically appear between one and four weeks after infection, though they can sometimes emerge earlier or much later. Many people with NGU experience no symptoms at all, which is why regular screening is encouraged. When symptoms do occur, they may include:

• A white, cloudy, or clear discharge from the tip of the penis.
• A burning or stinging sensation when passing urine (dysuria).
• An itchy or irritated feeling inside the urethra.
• Tenderness or discomfort in the genital area.

What Causes NGU?

By definition, NGU is not caused by gonorrhoea. Instead, the most frequent causes identified in the UK healthcare system include:

• Chlamydia: Responsible for nearly half of all NGU cases.
• Other STIs: Infections like Trichomonas vaginalis or Mycoplasma genitalium.
• Bacterial overgrowth: Occasionally, bacteria that usually live harmlessly in the throat or bowel can enter the urethra.
• Physical irritation: Use of soaps, antiseptic creams, or friction during sexual activity can cause non-infectious inflammation.

If you have symptoms suggestive of NGU, it is important to seek a diagnosis to prevent complications and stop the spread to partners. In the UK, testing usually involves a physical examination and a sample collection.

A healthcare professional or an online doctor may recommend a first-catch urine sample (the first 20ml of urine passed) or a swab from the urethra. These samples are tested for the presence of white blood cells (indicating inflammation) and to rule out Chlamydia and Mycoplasma genitalium. Following NHS protocols, you may be treated for NGU based on symptoms before the final laboratory results are back, particularly if there is a high clinical suspicion of infection.

The primary treatment for NGU is a course of antibiotics. The choice of medication depends on local UK prescribing guidelines and the suspected cause of the inflammation. Common treatments include:

• Doxycycline: Usually taken as a twice-daily tablet for seven days.
• Azithromycin: Often prescribed as a single dose followed by a 2-day course (or as a one-off larger dose, though this is less common now due to resistance patterns).

It is vital to complete the entire course of antibiotics, even if symptoms vanish within the first day or two. Failure to finish the medication can result in the infection returning or contributing to antibiotic resistance. Additionally, patients are advised to abstain from all sexual contact (including oral and protected sex) until they and their current partners have finished treatment and symptoms have resolved.

Seeking a consultation with an online doctor can be a convenient and confidential way to address concerns about NGU. You should consider booking a session if:

• You have noticed unusual discharge or pain when urinating.
• A sexual partner has informed you they have been diagnosed with an STI or urethritis.
• You have completed treatment but your symptoms have not improved after 14 days.
• You require a confidential environment to discuss sexual health concerns and obtain a prescription for UK-regulated pharmacies.

An online GP can assess your symptoms, provide advice on testing kits, and prescribe the appropriate antibiotics if a diagnosis of NGU is confirmed or highly likely. This service often provides a faster alternative to waiting for a local clinic appointment.

While NGU is usually straightforward to treat, ignoring symptoms can lead to more serious health issues. In men, untreated NGU can lead to epididymitis, which is the painful inflammation of the tubes that carry sperm from the testicles. This can occasionally impact long-term fertility.

If the infection is passed to a female partner, it can cause Pelvic Inflammatory Disease (PID), which is a serious condition that can lead to chronic pelvic pain or ectopic pregnancy. Proper diagnosis and partner notification are therefore crucial steps in the management of NGU.