Non-gonococcal urethritis. Symptoms, diagnosis, and treatment. How can we prevent the disease?

One of the most common sexually transmitted diseases that afflicts patients for a long time

by Dr. Ιlias Βoutis

Sexually transmitted diseases (STDs), that is, diseases that are transmitted through unprotected sexual intercourse, show an increase at an international level during the summer months, with Cyprus being no exception. Health promotion is the key to both avoid and prevent STDs, which results in their diagnosis and management. However, specific taboos circling around STDs by the society render this promotion difficult.

Non-gonococcal urethritis (NGU) is probably the most common sexually transmitted disease today. Due to incomplete diagnosis and treatment, it often afflicts patients for a long time. Possible causes of NGU include the parasitic bacterium Chlamydia (Chlamydia trachomatis), which is isolated in 50% of cases, and to a lesser extent, other microorganisms such as Ureaplasma urealyticum, Trichomonas vaginalis and secondary microbial agents such as Group B streptococci, anaerobic bacteria, Garnderella vaginalis and fungi. Risk factors are age (

Clinical image – Symptoms

50% of male patients may be asymptomatic. Symptoms begin one to three weeks after intercourse with an infected person. The first symptom is itching in the urethra which gradually intensifies to burning. Urination becomes painful and from the urethral meatus comes a white or cloudy discharge. In women, in 70% of cases, the infection may be asymptomatic. Symptoms include bleeding after sexual intercourse, vaginal discharge, pain around the pelvis or lower part of the stomach (abdomen), and dysuria.

Failure to proceed to treatment may result in complications in both sexes, namely prostatitis, orchitis, epididymitis, blood in semen, Reiter’s syndrome in men and infertility, Pelvic Inflammatory Disease (PID) and chronic pelvic pain in women. Furthermore, cervicitis can lead to neonatal conjunctivitis that is transmitted during childbirth and occurs on the 2nd to 5th day of life. Finally, infection of the anal canal with anal pain and anal secretion can also be observed.

Laboratory diagnosis

Although NGU is much more common, Gonococcal Urethritis should be ruled out at the time of diagnosis. Diagnosis is achieved by the creamy discharge which is directly stained with Gram technique to rule out gonorrhea, while the presence of chlamydia and ureaplasma is also examined. Examination of urethral-vaginal discharge is considered necessary to determine the cause of the disease and to select the appropriate treatment. In addition, special direct immunofluorescence (DIF) tests and serological tests of urethral or cervical secretions are performed.Checking for trichomonas is necessary, while serological tests for syphilis are also useful, to exclude possible coexistence.


Treatment for NGU is more effective at the onset of the disease than after months or years of recurrent NGU complications, which means that the patient should be referred to the treating physician immediately after the findings are confirmed. Treatment includes administration of the tetracyclines and macrolides antimicrobial groups. After treatment, follow-ups are required for at least 3 months.


Taboos often prevent information in general about STDs. For this reason, we observe that there are not enough preventive and diagnostic tests for these diseases. However, everyone should be aware that counseling and monitoring of both the healthy person and the patient respectively by the treating physician is the key to treating STDs. Early diagnosis by microbiologists and biopathologists and of course immediate treatment by the treating physician can prevent the progression of the disease and save lives. The annual screening of Sexually Transmitted Diseases in an ISO accredited laboratory is considered as necessary as the responsible sexual behavior. Unprotected sex is dangerous, which is why it is recommended to use a condom in every sexual intercourse.

*Biopathologist – Microbiologist, member of medical team of BIOIATRIKI Healthcare Group in Cyprus.