Nongonococcal urethritis (NGU) is an inflammation of the urethra that is not caused

by gonorrheal infection.
For treatment purposes, doctors usually classify infectious urethritis in two categories:
gonococcal urethritis, caused by gonorrhea, and nongonococcal urethritis (NGU). [1]

Causes[edit]
There are many causes of NGU.[2] This is in part due to the large
variety of organisms living in the urinary tract. Ureaplasma urealyticum
and Mycoplasma genitalium are some of the culprits.[clarification
needed]
Bacterial[edit]
The most common bacterial cause of NGU is Chlamydia
trachomatis[citation needed], but it can also be caused by Ureaplasma
urealyticum, Haemophilus vaginalis, Mycoplasma genitalium, and
E.coli.
Viral[edit]
Herpes simplex virus (rare), Adenovirus.[citation needed]
Parasitic[edit]
Parasitic causes include Trichomonas vaginalis (rare).[citation needed]
Noninfectious[edit]
Urethritis can be caused by mechanical injury (from a urinary catheter
or a cystoscope), or by an irritating chemical (antiseptics or some
spermicides).
Symptoms[edit]
The symptoms of urethritis can include pain or a burning sensation
upon urination (dysuria), a white/cloudy discharge and a feeling that
one needs to pass urine frequently. For men, the signs and symptoms
are discharge from the penis, burning or pain when urinating, itching,
irritation, or tenderness. In women, the signs and symptoms are
discharge from vagina, burning or pain when urinating, anal or oral
infections, abdominal pain, or abnormal vaginal bleeding, which may
be an indication that the infection has progressed to Pelvic
Inflammatory Disease.
NGU is transmitted by touching the mouth, penis, vagina or anus by
penis, vagina or anus of a person who has NGU.

NGU is more common in men than women. Men may have a discharge
(strange liquid) from the penis, pain when urinating, and itching,
irritation or tenderness around the opening of the penis. Women might
not have any symptoms and may not know they have NGU until severe
problems occur. Women might have discharge from the vagina,
burning or pain when peeing, pain in the abdominal (stomach) area, or
bleeding from the vagina that is not from a monthly period. (This may
be an sign that NGU has become worse and turned into Pelvic
Inflammatory Disease, or PID).
Diagnosis[edit]
It has been easy to test for the presence of gonorrhea by viewing a
Gram stain of the urethral discharge under a microscope: The
causative organism is distinctive in appearance; however, this works
only with men because other non-pathogenic gram-negative microbes
are present as normal flora of the vagina in women. Thus, one of the
major causes of urethritis can be identified (in men) by a simple
common test, and the distinction between gonococcal and nongonococcal urethritis arose for this reason.
Non-gonococcal urethritis (NGU) is diagnosed if a person with urethritis
has no signs of gonorrhea bacteria on laboratory tests. The most
frequent cause of NGU (23%-55% of cases) is C. trachomatis.[medical
citation needed]
Non-specific urethritis[edit]
In the United Kingdom, NGU is more often called non-specific urethritis;
[3][4][5] "non-specific" is a medical term meaning "specific cause has
not been identified", and in this case refers to the detection of
urethritis, and the testing for but found negative of gonorrhea. In this
sense, the most likely cause of NSU is a chlamydia infection.
However, the term NSU is sometimes distinguished and used to mean
that both gonorrhea and chlamydia have been ruled out.[6] Thus,
depending on the sense, chlamydia can either be the most likely cause
or have been ruled out, and frequently detected organisms are
Ureaplasma urealyticum and Mycoplasma hominis.
Treatment[edit]
Treatment is based on the prescription and use of the proper antibiotics
depending on the strain of the ureaplasma.[7]
Because of its multi-causative nature, initial treatment strategies
involve using a broad range antibiotic that is effective against
chlamydia (such as doxycycline).[medical citation needed] It is
imperative that both the patient and any sexual contacts be treated.

Women infected with the organisms that cause NGU may develop
pelvic inflammatory disease. If symptoms persist, follow-up with a
urologist may be necessary to identify the cause.
According to a study, tinidazole used with doxycycline or azithromycin
may cure NGU better than when doxycycline or azithromycin is used
alone.[8]
If left untreated, complications include epididymitis and infertility.
Consistent and correct use of latex condoms during sexual activity
greatly reduces the likelihood of infection.[citation needed]