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NSU - non-specific urethritis
Non-specific urethritis (NSU) is an inflammation of the tube which urine and semen pass through in a man’s penis, the urethra. This inflammation can be caused by several sexually transmitted infections, the most common being chlamydia, which affects both men and women (see NAM Factsheet 57). However, NSU can have some non-sexual causes. If left untreated it can cause reduced fertility, inflammation of the eyes and joints, and can increase the likelihood of passing on HIV. Although any man who is sexually active can get NSU, it’s seen most often in gay men.
Transmission
NSU is almost always caused by an infection which has been passed on during anal, oral and vaginal sex if no condom is used. Very rarely it can be caused by excessive friction during masturbation or sex, an allergic reaction to soap or detergent, or drinking too much alcohol.
Untreated NSU can make a person with HIV more infectious as the infections which cause it can cause breaks in the mucous membranes (the barriers) of the urethra and increase the number of HIV-infected cells in that area. Having NSU can also make it more likely that an HIV-negative person will be infected with HIV if they are exposed to the virus.
Prevention
Using a condom for anal, oral or vaginal sex is an effective way of avoiding the infections which cause NSU or passing NSU on to somebody else. People who are sexually active are advised to have regular check-ups where they will be tested for NSU and other sexually transmitted infections. Most HIV treatment centres have an associated sexual health clinic where free and confidential treatment can be obtained without referral from your GP or HIV doctor.
Symptoms
Symptoms of NSU normally develop within a week or so of infection, although some irritants, such as soap, can cause symptoms to occur almost immediately. However it is estimated that as many as 50% of men with NSU have no symptoms at all.
When symptoms do occur, they normally consist of pain or a burning sensation when passing urine, a white or cloudy discharge from the tip of the penis which may be particularly noticeable first thing in the morning, and more frequent urination.
Diagnosis
A general sexual health check-up at a genitourinary medicine (GUM) or a sexual health clinic, will include a test for NSU. GUM clinics are free, confidential and open access. Some HIV clinics also offer sexual health screening. NSU is diagnosed by taking a swab from the penis. These can be uncomfortable but are very quick to take. A urine sample may also be looked at for evidence of infection.
In many cases it will be possible to tell instantly if NSU is present, but it can take up to a week for tests to show if chlamydia is present.
Treatment
NSU is treated with antibiotics. Normally this consists of a seven day course of doxycycline or a single dose of azithromycin. It is important to take all your tablets to ensure that the infection has been eradicated from your body. Symptoms may persist for a few days after taking azithromycin as the antibiotic takes time to work.
When NSU is diagnosed, you may be given an opportunity to speak to a Health Adviser who can give you information about safer sex and how to avoid picking up or passing on sexually transmitted infections. Health Advisers may also ask you to help them, where possible or practicable, to contact your sexual partners so they can be tested and treated too. This in turn, is intended to prevent you from becoming re-infected through continuing to have sex with someone who is themselves infected.
You may be asked to return a week later for a test to see that you have been cured. You are likely to be advised not to have sex (even with a condom) until your treatment period has finished. This is to prevent re-infection.