Non-gonococcal urethritis

Non-gonococcal urethritis (NGU, sometimes referred to as non-specific urethritis) is a term used to describe the presence of urethritis when a gonococcal bacteria are not identifiable or the initial swab. A typical case would be a male who presented to a GUM clinic with a purulent urethral discharge and dysuria. A swab would be taken in clinic, microscopy performed which showed neutrophils but no Gram negative diplococci (i.e. no evidence of gonorrhoea). Clearly this patient requires immediate treatment prior to waiting for the Chlamydia test to come back and hence an initial diagnosis of NGU is made.

Causative organisms include:

• Chlamydia trachomatis - most common cause
• Mycoplasma genitalium - thought to cause more symptoms than Chlamydia

Management

• contact tracing
• the BNF and British Association for Sexual Health and HIV (BASHH) both recommend either oral azithromycin or doxycycline