Often abbreviated to NSU for convenience, non-specific urethritis is a condition with some unpleasant symptoms. In this article we take a broad look at NSU and the ins and outs of the condition.
Introduction to NSU
NSU is also known as non-gonococcal urethritis for reasons soon to be discussed, and the condition affects a particular part of the body called the urethra. Both men and women possess a urethra, which is essentially the tube running from the bladder and out of the body. As you might imagine, the purpose of the urethra is to carry urine out of the body, and so it is an important part of our natural waste disposal system.
NSU involve a painful inflammation of the urethra, and the condition fits under a broader category of conditions called urethritis. NSU in particular earns its name from the fact that no distinctive cause for the condition can be determined. The condition is often referred to as non-gonococcal urethritis (NGU) because one of the more common causes of urethritis is gonorrhoea, and instances where the condition is not caused by gonorrhoea can be classed as NGUs.
While no specific, determinable cause of NSU is one of the hallmarks of the condition, we do have some understanding of what may be causing the condition. It is thought that even though an infection may not be detected in the course of looking into NSU, at least half of all male conditions are actually caused by the sexually transmitted disease chlamydia. In some cases NSU is caused by injury or blockage of the urethra, and the use of some products like creams and soaps can cause the urethra to become inflamed.
Interestingly women suffering from NSU will rarely present with any symptoms, while men will often suffer notably from the condition. An estimated 80,000 cases of NSU are reported by men in the UK every year, and the condition can be diagnosed through urine tests or swabs of the urethra.
Male sufferers of NSU will most often report a painful burning during urination, often alongside pain and irritation at the end of the penis. In some cases there can be a cloudy discharge from the end of the urethra.
Fortunately despite its prevalence and unpleasant symptoms, NSU is very treatable. Antibiotics are prescribed to combat the infection responsible for the symptoms and the condition itself. The treatment can last about two weeks, and it is important that former sexual partners are spoken to about the condition in case it has been caused by an STI. These steps are taken to address the issue of sexually transmitted disease and prevent the spread of STIs, as well as to provide infected peoples with any treatment they might need.
Safe sex is one of the best ways to prevent the unwanted spread of NSU as the majority of cases stem from infection with chlamydia. This means using a barrier method of contraception like a condom to prevent the unwanted exchange of bodily fluid that can result in the transmission of NSU causing sexually transmitted infection.
Symptoms of Non-Specific Urethritis
Non-Specific Urethritis is the inflammation of the tube responsible for carrying urine from the bladder and out of the body. The condition has become an issue in the UK as many incidences can be attributed to sexually transmitted infections, many of which have been on the rise in the country. Often abbreviated to NSU, non-specific urethritis can have some unpleasant effects, and in this article we look specifically at the symptoms of the condition.
Signs and symptoms of NSU in men
A diagnosis of non-specific urethritis is given when no specific cause for urethritis can be found and disclosed to the patient. Despite this being the case, we do have an understanding of a number of different injuries and infections which can lead to the condition, and as such despite its vague nature, the disease does have distinctive symptoms.
In men the symptoms of NSU are far more obvious, and in most cases, painful. One of the most prevalent symptoms of NSU is a painful burning sensation during urination which can often be experienced alongside irritation or pain at the tip of the penis. This pain and discomfort is often compounded by an increased frequency of urination, and some men will find a milky white discharge from the end of their penis.
These symptoms can typically begin days, weeks, or even months after the actual infection, and this can be indicative of the cause of the disease. Many cases of NSU are actually due to some kind of injury or exposure to some soaps and creams, and in these instances symptoms develop within a couple of days of the incident responsible. Where an infection is responsible, which is often the case amongst men suffering from NSU, the nature of the infection will determine how long it can be before symptoms arise. It is important to point out that if you have symptoms a few days after sex then it is unlikely the condition is caused by a sexually transmitted infection as these will take much longer to manifest with urethritis. That being said, you should still pursue any necessary STI testing where possible.
If you have had unprotected sexual intercourse with someone who has been diagnosed with an STI and potentially NSU, you should get yourself tested regardless of whether or not you have shown any symptoms. Again, signs of the disease can take much longer to develop, and getting tested can allow you to get any treatment you need before the symptoms of urethritis, which are unpleasant in men, can begin.
Even if your symptoms pass, you should still go to your doctor and try and determine the cause of the condition. In some cases symptoms can come and go, and getting tested and treated can spare you some considerable discomfort.
Signs and symptoms of NSU in women
While most women won’t develop any symptoms of their NSU, the condition is still cause for concern. Left unchecked, the infection responsible for NSU can spread into other parts of the reproductive tract, which include important structures like the womb (uterus). Infections that make their way into the rest of the female track become classified as PID or pelvic inflammatory diseases, and these are serious conditions that can cause chronic pain issues and potentially influence fertility.
PID will typically involve pain around the pelvis and abdomen, some pain or at the very least discomfort during sex, irregular bleeding between periods and after intercourse, in some cases distinctive vaginal discharges and a fever.
The lack of symptoms in the early stages of infection (NSU) can make it difficult to treat the condition before it progresses to cause PIDs, which is why it is important to practice safe sex and avoid one of the causes of urethritis: sexually transmitted infection. If you have had unprotected sex and are worried about developing NSU you should speak to your doctor about potentially getting tested. If you are told that a former or current sexual partner is carrying an STI you should definitely get testing to ensure that you don’t bear the condition or get the treatment you need if you do.
Despite the discomfort of the symptoms of NSU (for men), the condition is very treatable, so if you do think you suffer from non-specific urethritis you should speak to your doctor who will be able to diagnose you and provide you with the antibiotics that can resolve the condition within a couple of weeks.
Causes of Non-Specific Urethritis
Non-Specific Urethritis is often referred to as either NSU or NGU (standing for non-gonococcal urethritis). The condition can have unpleasant symptoms for men and lead to serious medical consequences in women, which is why its diagnosis and treatment is so important. In this article we look at the potential causes of non-specific urethritis.
Infectious causes of NSU
Sexually transmitted infections are thought to be one of the major causes of non-specific urethritis, particularly amongst men. In cases where STIs are responsible for the illness, your diagnosing physician will have been unable to detect which specific infection is responsible for the inflammation of the urethra involved in urethritis, this lack of a specific causative effect of the condition is what causes urethritis to be classed as non-specific.
Chlamydia is a relatively common sexually transmitted infection which is thought to cause at least half of all cases of non-specific urethritis in men, and about 40% in women. Chlamydia is a bacterial infection transmitted through any unprotected sex, including anal and oral intercourse. The bacteria responsible is called Chlamydia trachomatis, and infection with this bacteria can, if left untreated, cause more serious medical issues as well as urethritis.
This is why the practice of safe sex is an important method of avoiding NSU, and why you should have yourself tested for the condition if you or either a former or current partner are diagnosed with chlamydia.
Other bacteria and microorganisms can also potentially cause non-specific urethritis, and these can often be found living harmlessly in other parts of the body. Our throats, rectums, mouths, and digestive tract are rich in harmless bacteria which can cause urethritis should they come into contact with the urethra. In most cases exposure to these otherwise safe bacteria occurs through sexual intercourse.
Relatively common infections and infectious agents causing NSU here in the UK include bacteria like Mycoplasma, parasites like Trichomonas Vaginalis, and viruses like herpes which are responsible for herpes and cold sores. In these cases, as with chlamydia, it is important to be tested so that your doctor can provide you with any necessary treatment.
While infections may be one of the primary causes of non-specific urethritis, there are many examples of the condition being caused by injury or exposure to irritants. In these cases contact with a foreign object causes the urethra to become inflamed, and as this structure is responsible for the transport of urine from the bladder and out of the body, also causes the characteristic painful urination experienced by men suffering from NSU.
Inflammation is one of the body’s natural responses to foreign bodies and trauma, and while it can be painful and cause unpleasant effects, its purpose is important. Your body triggers inflammation when exposed to injury or a potentially harmful substance, and in doing so, isolates the affected site so as to better launch an immune response against it and to prevent the spread of potentially harmful substances or organisms to the rest of the body. In NSU, this inflammation restricts the size of the urethra and results in the painful expulsion of urine in men.
Irritants that can cause NSU are largely chemical products like certain soaps, spermicides, oils, lubricants, or deodorants. It is important to handle any such substance with care when near your genitals, and unless you are sure about the safety of the substance in question, you should not apply it to your penis.
NSU can also be caused by trauma to the urethra triggered by overly vigorous sexual activity. This includes both intercourse with a partner and masturbation, either of which can damage the urethra if performed unsafely.
A number of NSU cases are caused by the insertion of a material into the urethra. A relatively common example of NSU as a consequence of this is where catheters are inserted into the urethra. A catheter is essentially a bag into which urine can flow where a person is facing difficulties with bladder control or access to urinary facilities (e.g. because of movement issues or when bedbound for surgery). The application of a catheter involves inserting a lubricated tube into the urethra to access the bladder, and in some cases this process can damage the urethra and trigger an inflammatory leading to NSU.
Regardless of cause, a diagnosis of NSU is usually a good thing as it means your doctor can start administering the necessary treatment. Understanding why NSU has been caused influences treatment choices in some cases of course, for example NSU caused by an infection can be cleared up by addressing that underlying infection, which is why it is important that the necessary tests and patient history are provided by and to your doctor respectively.
Treatment of Non-Specific Urethritis
NSU, also known by its full name, non-specific or non-gonococcal urethritis, is a condition that has been on the rise in the UK alongside the spread of STIs which can cause it. Fortunately despite the discomfort and pain associated with the symptoms of the condition in men (NSU is largely asymptomatic in women), the condition is very treatable, and in this article we look at how non-specific urethritis can be treated once diagnosed.
Treatment of NSU
NSU is primarily treated through a short course of antibiotics your doctor will provide you once a diagnosis of NSU has been made. You can arrange to see medical health professionals at specialised sexual health or genitourinary medicine clinics, and these individuals are capable of prescribing any necessary medications.
Antibiotics are specially formulated drugs with an anti-bacterial action from which they derive their name. As most cases of NSU are caused by a bacterial infection of some sort, antibiotics are an effective and fast acting way of clearing up the condition. Antibiotics are actually also used where NSU isn’t caused by an infection, but by trauma or exposure of the urethra to irritants like soap, creams, or foreign objects. In these instances despite the non-infectious cause of NSU, there is often an element of infection which can be effectively addressed through antibiotics.
These antibiotics are not available over the counter, and you will need a prescription from one of the previously mentioned sources to gain access to the drugs. The two most commonly used antibiotics are azithromycin and doxycycline. The former is given as a single dose that you only need to take once, while the latter needs to be taken twice a day over the course of a week.
Following the instructions associated with the administration of the antibiotic in question will hopefully lead to the infection being treated. You won’t need to revisit the clinic, but you will have to make sure that you have informed your recent sexual partners about the condition as it is infectious and they might need treatment. You should also avoid any sex for at least a week to prevent any further transmission of the illness, and it can take up to three weeks for symptoms to completely clear.
It is absolutely critical that you avoid sex of any kind, be it vaginal, oral, or anal, whilst taking your medication (or in the week after taking azithromycin). During this time despite the antibiotics there will still be bacteria around your urethra which can be transmitted to someone else. Ideally you should avoid sex until you have no symptoms at all, even if this can take a couple of weeks.
There are cases where despite following the course of prescribed antibiotics, there is no resolution of symptoms two weeks after you have been given antibiotics. Should this occur, you should visit your local sexual health or genitourinary medical clinic to follow up on your care. In some cases, your symptoms might persist because the infection was passed back to you by a sexual partner.
You will probably be asked to go through a number of tests to look for any sexually transmitted infections that might underlie your NSU and contribute to it. Your doctor may prescribe a different set of antibiotics and follow up on your treatment in that way.
Prognosis of Non-Specific Urethritis
NSU (non-specific urethritis) is a condition that has become a bigger concern in the UK in recent years alongside the spread of sexually transmitted infections, one of the more common causes of NSU. NSU’s symptoms can be particularly unpleasant for men, how will experience pain while urination and an increase in their need to do so. While women don’t often experience any overt symptoms of the condition, NSU can become a more serious and complex condition affecting the reproductive tract if left untreated.
In this article we look at the prognosis of non-specific urethritis both without and with treatment.
Prognosis of NSU without treatment
The prognosis of NSU without treatment varies depending on gender. Men who don’t receive treatment from the infection will have to put up with the symptoms for some time, but in most cases will resolve over time. In cases where the NSU is actually a consequence of an underlying sexually transmitted infection it is important to seek treatment where possible to prevent the further spread of the STI or complicating effects of the infection.
Women who don’t receive treatment for their NSU can often suffer the progression of NSU to PID, or pelvic inflammatory disease. This is a more serious condition which involves the spread of non-specific urethritis to other structures of the female reproductive tract like the womb. PID can have more serious consequences and needs to be treated quickly. In the long term PID can increases the risk of infertility and a pregnancy complication where an embryo implants somewhere that isn’t the uterus (referred to as ectopic pregnancy).
If left untreated NSU in both men and women can result in a condition called persistent urethritis, where there NSU seemingly resolves and then recurs. Recurring NSU can occur after receiving treatment for the condition as well, and is thought to affect about 20% of male NSU sufferers anda number of women as well.
Prognosis of NSU after treatment
NSU is very effectively treated with antibiotics, antibacterial drugs which attack the bacteria most often responsible for urethritis. The drugs are also administered in cases where urethritis is a consequence of injury as there is sometimes an infectious component in these instances as well.
It is important to follow the instructions provided with any course of antibiotics. The two most often applied to NSU are a seven day course of doxycycline (with two doses a day), or the substantially simpler single dose required for azithromycin. If the instructions are followed then the prognosis for NSU is very good, with symptoms resolving within 2-3 weeks. If symptoms don’t clear up then it may become necessary to seek further treatment and testing, and you should speak to a specialist at either a sexual health clinic or a genitourinary medicine clinic. In some cases alternative antibiotics may be prescribed, and most of the time some further testing for STIs will be performed.
Diagnosing Non-Specific Urethritis
Non-Specific Urethritis in Men
While urethritis is a concern for both sexes, the infection itself is a completely different experience for men and for women. In this article we look at how non-specific urethritis can affect men in particular.
Symptoms of male NSU
Often abbreviated to NSU for convenience’s sake, non-specific urethritis is a condition that has become increasingly prevalent alongside the rise and spread of sexually transmitted infections in recent years.
Men experience NSU differently because of the anatomy of the affected structure, the urethra, in the male body. The urethra is the tube which because inflamed (swollen and painful) during NSU. The urethra is the structure responsible for carrying urine out of the bladder, through the penis, and finally out of the body. When inflamed, the urethra causes a number of unpleasant symptoms in men because of the association of this tube with the penis.
One of the major differences between men and women experiencing NSU lies in the symptoms experienced. Most women with NSU won’t experience any symptoms at all, while men suffering from the disease will often suffer a painful burning sensation whilst urinating, pain at the end of the penis, and in some cases a milky discharge is released from the end of the penis. These unpleasant symptoms are also compounded by an increase in the frequency of urination, and in some cases pain in the abdomen.
Causes of NSU in men
About 50% of cases of male NSU are thought to be attributed to chlamydia, a sexually transmitted infection with a number of other effects including the inflammation of the urethra. A number of cases are also attributed to injury, either through exposure to irritant materials like certain soaps and creams or through objects being inserted into the end of the penis. A good example of the latter is the insertion of a catheter tube into the urethra, which is more likely to cause injury to men than women because of our differences in anatomy.
Prognosis, treatment, and Complications of NSU in men
One of the differences in the condition as experienced by the sexes is also the long term effects of NSU. In men the condition can often resolve, even without treatment, however if left unattended in women NSU can quickly become a much more insidious and serious condition. Untreated non-specific urethritis progresses to form a condition called pelvic inflammatory disease, an affliction which spreads to important structures in the female reproductive tract and can affect fertility.
Men can still suffer some unpleasant complications of NSU. Recurrent urethritis is a condition which can affect about 20% of men compared to a very small number of female incidences. Recurrent NSU is essentially just a repeat infection, which will often warrant further testing and treatment to address what is usually an underlying infectious cause.
Less than 1% of male sufferers of NSU will experience a complication of NSU called Epididymo-Orchitis, a combination of two inflammatory conditions called epididymitis and orchitis. The former is an inflammation of the epididymis, a tube which stores and transports sperm through the testicles, and the latter is the general swelling and inflammation of the testicls.
In terms of treatment men are provided with the same courses of antibiotics as women. In the UK this is typically either a single dose of azithromycin or a week long regimen of doxycycline. If taken as advised, these are extremely effective antibiotics which can treat male symptoms within 2-3 weeks of administration. There are instances where the treatment may not successfully clear up the condition, and in these cases you should go back to your doctor for further testing as it is likely that there is an underlying sexually transmitted infection which is causing recurring episodes of urethritis.
While the long term consequences of NSU are less severe amongst men, the condition does have painful symptoms which warrant quick treatment. Fortunately men who follow the treatment instructions will, in most instances, quickly recover from the condition.
Non-Specific Urethritis in Women
Non-specific urethritis goes by a number of different monikers, including NSU and NGU (non-gonococcal urethritis), and is a condition that has become a growing concern amongst the medical community as it is often linked to sexually transmitted infections. In this article we look at NSU in women as the condition is experienced differently by the sexes due to biological differences in the structure and functions of the urethra and reproductive system.
Causes of NSU in women
Women in the UK are thought to suffer NSU as a result of sexually transmitted infections (STI) or injury to the urethra. The urethra is the structure affected by the condition and from which the illness draws its name. This structure is a tube which runs from the bladder and out of the body, and in NSU it becomes inflamed as part of an immune response (the actions of our body’s natural defences) to infection or injury.
About 40% of cases of NSU are thought to be caused by chlamydia infections. Chlamydia is a relatively common sexually transmitted disease which spreads through unprotected sexual contact be it vaginal, oral, or anal.
While a large portion of infectious cases of NSU in women are thought to be a consequence of chlamydia, there are a host of other bacteria which may reside in the mouth, throat, or anus which can cause non-specific urethritis. These bacteria are usually harmless in their usual environment, and only cause harm once within the urethra. Examples of these bacteria include Mycoplasma and Trichomonas Vaginalis.
Viruses can also potentially cause an inflammation of the urethra in women, although cases of NSU caused by viral infection are less common than in men. The adenovirus, which will typically cause a sore throat, or the herpes virus are good examples of viral causes of urethritis.
In some instances NSU is caused by injury or exposure to irritant materials. A chemical product like a soap or cream used near the genitals can potentially cause the urethra to inflame, which is why it is always important that both men and women take care when applying any material to their genitals. Injury, most commonly through the insertion of a catheter, can also cause an inflammatory response and trigger NSU. Catheters are tubes which are lubricated and then run up the urethra and into the bladder to provide relief for people who might not be able to urinate normally for medical reasons. While care is taken in the application of catheters and a lubricant is used, their placement an cause urethritis.
Symptoms of NSU in women
Interestingly while most men will experience symptoms like a burning during urination or a discharge from the end of the penis, women very rarely demonstrate any symptoms or signs of non-specific urethritis. The condition is quite insidious in this respect as without any symptoms it is often left untreated, and can develop into a far more serious condition. If caused by a sexually transmitted infection, then the fact that NSU has no symptoms can lead to the unwitting transmission of the STI.
Prognosis and Treatment of NSU in Women
If left untreated, a severe cause of non-specific urethritis can develop into a pelvic inflammatory disorder, a condition with more serious implications for women. Men don’t develop PID, and in most cases NSU in men will resolve even without treatment. Because of how serious PID can be in women, diagnosing and treating NSU quickly and effectively is extremely important.
PID occurs when the infectious agent causing NSU spreads to the rest of the reproductive tract, including important and sensitive structures like the uterus or fallopian tubes (which link the uterus to the ovaries). Ultimately untreated PID can affect a woman’s fertility and cause what are known as ectopic pregnancies. An ectopic pregnancy is when a fertilised egg implants in an abnormal location rather than the womb, most commonly the fallopian tubes.
Other complications of untreated NSU include persistent NSU, a condition where the inflammation of the urethra recurs regularly. If your symptoms recur following treatment, you are likely to suffer from persistent NSU and should consult your doctor for further testing and treatment. Persistent NSU is rarer in women than in men, but it does occur.
Reiter’s syndrome is also an extremely rare complication of NSU which may affect about 1% of sufferers. The condition is also described as reactive arthritis, and occurs when the body’s immune system chooses to attack its own, healthy cells rather than the infectious agent causing NSU. This type of faulty action is called an autoimmune condition, and is thought to be a result of a confusion in the immune system’s ability to perceive and identify ‘self’ and foreign materials. Reiter’s syndrome can cause pain in the joints, conjunctivitis, and recurring urethral inflammation.
The treatment of NSU in women is exactly as it would be amongst men and usually involves the administration of one of two first line antibiotic treatments. Doxycycline is given as a weekly regimen of 2 doses a day, while azithromycin is administered as a single dose you only need to take once. If your symptoms don’t clear up within 2-3 weeks of treatment (if you are experiencing any symptoms that is), then your doctor will usually run more tests and switch to alternative treatments.
While the condition shares some distinctive similarities in both men and women, there are fundamental differences in how the disease can be experienced by the sexes, and in the complications it can cause if left untreated. Because women rarely experience symptoms and the untreated infection can cause serious complications, it is important that unprotected sex with multiple partners be avoided as this hugely increases the risk of STI based NSU.
Complications of Non-Specific Urethritis
Many different infections can cause complications in certain cases, particularly if left untreated. Because of the nature of the site affected by non-specific urethritis, namely the urethra which is found near the genitals, complications of the condition can have serious consequences to men and women who suffer from the disease and develop complications.
The complications of NSU are a particular concern amongst women as many female sufferers of the condition do not experience any symptoms. This means that the condition can be difficult to pick up and therefore treat, increasing the chances of the infection progressing to cause a more serious disease which will be discussed later in this article.
General complications of NSU
Both men and women can develop recurring NSU, which is potentially the most common complication of the condition. In most cases NSU will clear up after a course of antibiotic treatment however, in some instances symptoms will return, indicating a repeated infection. This condition is also called persistent urethritis, and is thought to affect about 2 in every 10 male sufferers of NSU and a smaller number of women.
Persistent urethritis often requires further testing and another round of treatment. Recurring infections usually indicate that there might be another underlying condition, like a sexually transmitted infection, which requires attention before the urethritis itself can be completely cleared up.
Reiter’s syndrome is another potential consequence of NSU, albeit a much rarer one. The condition is also referred to as a type of reactive arthritis, and belongs to a class of conditions known as autoimmune diseases. These conditions are typified by a faulty reaction from our body’s natural immunity which results in an attack on the body’s own tissues and cells rather than an infectious agent. In this case, the autoimmune response is triggered by the presence of the infectious agents causing NSU.
Reiter’s syndrome will typically present with an inflammation and swelling of the joints which is quite painful, as well as conjunctivitis and potentially other symptoms. Reiter’s is quite rare, but can affect sufferers of urethritis. The best way to address the reactive arthritis is to properly treat the infectious cause of urethritis, and potentially providing treatments to alleviate the symptoms of Reiter’s. The former treatments will usually be a course of antibiotics which, upon clearing the NSU, will remove the stimulus causing the body’s autoimmune response. The latter will be pain killing medications and anti-inflammatories which will am to make the painful symptoms of Reiter’s manageable.
Complications of NSU in Male Patients
Because of the distinct differences in the anatomy of male and female genitals and urethras, men and women experience can potentially experience different complications of the condition as well as the more general complications disussed bov
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