|  | Healthcare Industry | HMOs

Non-Gonococcal Urethritis (NGU): Symptoms, Causes & Treatment

Non-gonococcal urethritis (NGU) is urethral inflammation caused by pathogens other than Neisseria gonorrhoeae. It is a common sexually transmitted infection.

Etiology

  • Chlamydia trachomatis: 30–50% of cases.
  • Mycoplasma genitalium: 15–25%; rising, often macrolide-resistant.
  • Ureaplasma urealyticum, Trichomonas vaginalis, HSV, adenovirus: Less common.
  • Non-infectious: Chemical irritation, trauma, catheterization.

Symptoms

MaleFemale
Urethral discharge (clear/white)Often asymptomatic
Dysuria, urinary frequencyDysuria, frequency
Urethral itching/burningVaginal discharge, intermenstrual bleeding
Epididymitis (complication)PID, cervicitis (complications)

Diagnosis

  • NAAT (PCR) for C. trachomatis, M. genitalium, T. vaginalis from urine or swab.
  • Gram stain: ≥5 WBC/HPF suggests NGU; no gram-negative diplococci (rules out GC).

Treatment (CDC 2021 Guidelines)

  • First-line: Doxycycline 100 mg PO BID × 7 days (covers Chlamydia, M. genitalium*).
  • Alternative: Azithromycin 1 g PO single dose (less effective for M. genitalium).
  • M. genitalium resistance: If macrolide resistance suspected/confirmed → moxifloxacin 400 mg PO daily × 7–14 days.
  • Partner treatment: Expedited partner therapy (EPT) recommended.
  • Test of cure: 3–4 weeks for M. genitalium; not routine for Chlamydia unless pregnant.

Prevention

  • Condoms, mutual monogamy, regular screening.

*Doxycycline preferred over azithromycin for NGU due to M. genitalium coverage.

HMOs - Related Articles