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Non-specific Urethritis (NSU) which used to be known as NGU (Non-gonococcal urethritis), is a common STI-related condition that refers to any inflammation of the urethra (the tube that carries urine out of the body) that is not caused by an identified bacterial STI (gonorrhoea, chlamydia or mycoplasma genitalium). It can be transmitted through sex or through other activities. NSU infections can cause discharge, burning and/or urethral discomfort but may also be asymptomatic. NSU primarily affects people with penises. People with vulvas can get NSU, but it can be harder to diagnose as it does not cause many symptoms. 

NSU can be caused by several different bacteria or viruses, including those that cause other STI or may be caused by a non-STI bacteria or virus. 

NSU is usually treated with a short course of antibiotics, and you are unlikely to recover without treatment. If left untreated, NSU may lead to more serious infections.

Signs and Symptoms

NSU can be asymptomatic, but if symptoms do occur, they will often be within 2 to 35 days of exposure. They can also appear many months later. If left untreated, the infection can spread to other body areas, such as the prostate, testicles, cervix, or bladder.

Penis

NSU can present no symptoms at all. If signs or symptoms are present, there may be:

• Slightly white or clear urethral discharge
• Irritation when passing urine
• Swelling or tenderness in one or both testes
• Redness at the opening of the urethra

Vagina/Vulva

NSU often presents no symptoms at all. If signs or symptoms are present, there may be:

• Often no symptoms, but maybe a change in vaginal discharge
• Pain and bleeding when having sex
• Symptoms of Pelvic Inflammatory Disease (PID) may develop if NSU is left untreated

Common Causes

NSU infections are most commonly caused by unprotected vaginal, anal or oral sex. It can also be passed on when sharing sex toys. 

NSU can also be caused by deodorant, soap, phimosis, inserting objects such as urethral sounds or catheters into the urethra, excessive friction during sex or masturbation, ​​or by frequently squeezing the urethra.

Only sexually-transmitted NSU is contagious.

Prevention

You can prevent NSU infection by:

• Using condoms and dams for oral, anal and vaginal sex
• Using condoms when sharing sex toys
• Avoiding activities and products that irritate the urethra 
• Using undamaged, sterile equipment (like sounds, catheters, etc) for urethral play (particularly relevant to sex workers who provide BDSM, medical play, kink or fetish services)

It is recommended that you always change condoms when going from anal to vaginal or oral sex.

Testing 

Here’s some information about testing for NSW. You can view a list of sex worker-friendly sexual health clinics at our Where To Test page.

Testing Method

• Swab test
• Urine test
• General sexual health screening to rule out other potential infections

When to Test

• When you have symptoms
• If a partner has tested positive for NSU

Other Info

• NSU can be asymptomatic, especially in people with vaginas, and it is common for very mild symptoms to be ignored.
• NSU is not included in regular sexual health screening but is usually diagnosed after other STI have been ruled out.
• Sexual health clinic testing is often bulk billed, even if you don’t have Medicare, so the test will most likely be free.
• If you see a GP, you may pay a fee or be bulk billed. 

Treatment

NSU is easily treatable. Here’s what you need to know about treating it.   

Treatment Method/s

• NSU is usually treated with a course of oral antibiotics.
• ​​Continued or recurring symptoms may require specialist treatment.

Costs and Other Information 

• You remain contagious until you finish your antibiotics and your symptoms go away.
• Treatment cost will depend on which antibiotic you are prescribed.
• Sexual health clinic treatments are often bulk billed, even if you don’t have Medicare, so the treatment may be free. 
• If you see a GP, you may pay a fee or be bulk billed. 
• NSU is cured by effective treatment, but you do not develop immunity. It is possible to get another infection.

How might this impact my work? 

Practical Considerations

• It is recommended that you not resume having sex until you have finished your medicine and your symptoms are gone.
• If you can’t avoid having sex, then using a condom will help lower the chance of transmitting NSU, but there is no guarantee.
• NSU can also increase the chances of passing on HIV infection due to breaks in the mucous membrane of the urethra.
• Some antibiotics can reduce the effectiveness of oral contraception (‘the pill’). 
• If you often get thrush when you take antibiotics, you may want to take probiotics during and after your treatment to help prevent this.