Dr Dulcy Rakumakoe
7 minute read
12 Oct 2020
11:03 am

Healthy living :Why it may hurt to wee

Dr Dulcy Rakumakoe

Non-gonococcal urethritis: if it’s not caused by gonorrhoea

Image : Istock

Urethritis is inflammation of the urethra, the tube that carries urine from the bladder out of the body. It is usually caused by an infection. The term non-gonococcal urethritis (NGU) is used when the condition is not caused by gonorrhoea.

 If you think you have NGU, you should visit your local general practitioner for examination and tests.
NGU can have a number of possible causes, including irritation to the urethra and sexually transmitted infections (STI). chlamydia causes up to 43 of every 100 cases of NGU.
There are many cases of NGU where no infection is found. If no cause is found, you will still be offered treatment for possible infection.

This is also the case if inflammation is caused by an object such as a catheter in the urethra, or by using creams and soaps around the genitals. Urethritis is the most common condition diagnosed and treated among men in clinics. Around 80 000 men are diagnosed with urethritis every year.

It is more difficult to diagnose in women because it may not cause as many symptoms. Symptoms In women, NGU rarely has any symptoms unless the infection spreads to other parts of the reproductive system, such as the womb or fallopian tubes (which connect the ovaries to the womb).

If the infection does spread, a woman may develop pelvic inflammatory disease (PID). This is a serious health condition that can cause persistent pain. Repeated episodes of PID are associated with an increased risk of infertility. Some women with PID don’t have symptoms.

 If there are symptoms, they include:
 Pain around the pelvis or lower part of your stomach;
 Discomfort or pain during sexual intercourse that is felt deep inside the pelvis; v Bleeding between periods and after sex;  Pain when you urinate;
Heavy or painful periods;
 Unusual vaginal discharge, especially yellow or green. A few women with PID become very ill with:
 Severe lower abdominal pain; A fever;  Nausea and vomiting. Symptoms in men include: v A painful or burning sensation when urinating.
The tip of the penis feeling irritated and sore;
 A white or cloudy discharge;
A frequent need to urinate.
Depending on the cause, symptoms may begin a few weeks or several months after infection. If NGU has a non-infectious cause, such as irritation to the urethra, symptoms may begin after a couple of days. Symptoms that start a day or two after sex are usually not caused by an STI, but testing for STIs is still recommended.
If a current or recent sexual partner informs you that you may have been exposed to a STI that can cause NGU, but you don’t have symptoms, don’t assume that you do not have NGU. If this happens, it is always recommended that you get tested. You should still seek treatment if the symptoms of NGU disappear on their own.
Diagnosis There are two tests – a swab test and a urine test and both may be carried out to ensure the diagnosis is correct. It is recommended you are also tested for gonorrhoea and chlamydia. These are STIs that often cause urethritis. You may also be offered tests for other STIs, including HIV. A test for all infections is recommended.

A swab test involves taking a small sample of fluid from your urethra. The sample is examined under a microscope to look for evidence of inflammation or bacteria known to cause NGU. A urine sample will be tested for bacteria known to cause NGU.

Treatment :
Make sure you take your treatment as prescribed; make sure all your recent partners get the treatment; do not have sex until a week after everyone has been treated.
NGU is usually treated with a short course of antibiotics. Treatment with antibiotics may be started before you receive your test results.
A C-reactive protein test can be conducted to confirm whether the cause is infective so you are not given antibiotics unnecessarily. Most people with NGU are prescribed antibiotic tablets or capsules.
This may be:
Azithromycin – which is taken just once as a single dose v Doxycycline – which is taken twice a day for seven days Antibiotics may cause some side-effects, such as feeling sick, vomiting, diarrhoea and thrush.
Antibiotics used to treat NGU may interact with the combined contraceptive pill and the contraceptive patch. If you use these methods of contraception, your GP or nurse can advise you about which additional contraception is suitable.

Informing partners:

It is important that your current sexual partner is tested and treated if you are diagnosed with non-gonococcal urethritis (NGU). Any sexual partners you have had since being exposed to the sexually transmitted infection (STI) will also need to be informed, so they can be tested and treated.

It is suggested you inform any person you have had sex with in the last three months, but this timeframe can vary. Some people can feel angry, upset or embarrassed about discussing STIs with their current or previous partners. However, don’t be afraid to discuss your concerns with your doctor.

They can advise you about who to contact and the best way to contact them. With your permission, the clinic can arrange for a letter to be sent.

The letter will explain they may have been exposed to an STI and advise them to have a check-up. The letter does not have to have your name on it.

Nobody can force you to tell any of your partners about your STI, but it is strongly recommended you do. Left untested and untreated, STIs such as chlamydia can have serious effects on a person’s health, particularly women.

Informing partners:

It is important that your current sexual partner is tested and treated if you are diagnosed with non-gonococcal urethritis (NGU). Any sexual partners you have had since being exposed to the sexually transmitted infection (STI) will also need to be informed, so they can be tested and treated.

It is suggested you inform any person you have had sex with in the last three months, but this timeframe can vary. Some people can feel angry, upset or embarrassed about discussing STIs with their current or previous partners. However, don’t be afraid to discuss your concerns with your doctor.

They can advise you about who to contact and the best way to contact them. With your permission, the clinic can arrange for a letter to be sent.

The letter will explain they may have been exposed to an STI and advise them to have a check-up. The letter does not have to have your name on it. Nobody can force you to tell any of your partners about your STI, but it is strongly recommended you do. Left untested and untreated, STIs such as chlamydia can have serious effects on a person’s health, particularly women.

Complications of untreated chlamydia include:
Infection of the testicles in men;  Infection of the cervix (neck of the womb) in women;
Pelvic inflammatory disease which can increase the risk of infertility and ectopic pregnancy.
Complications of non-gonococcal urethritis include:
Persistent urethritis – the most common complication. Still having urethritis one to three months after being treated affects one or two men in every 10 and can affect women, too.
Reactive arthritis – an uncommon complication
Epididymo-orchitis in men.
Pelvic inflammatory disease in women.

 Ask the doctor

Dear doctor

What is the best route to take with a child who constantly has a stomach ache? My 8-year-old has a stomach ache at least once a week to the point where he won’t eat.

Stomach ache is a common non-specific symptom in children that age. Sometimes they experience fever too. There could be a dietary issue, or issues with any parts of the gastro and urinary tract system, for instance. Especially if this affects their ability to eat. Take the child to a doctor for a full history and examination.

The history will also include any recent events that might have affected the general well-being of the child, mentally or physically.
Dear doctor
What age does arthritis start? Does it affect sports people more?

There are generally two types of arthritis, inflammatory or the degenerative. The inflammatory one can happen at any age, even in children. It is mostly hereditary, but can happen following infections as well. Degenerative arthritis tends to be more common in the elderly after years of using the joint.

Abnormal, overuse or persistent use of joints definitely predisposes sports people to developing it. Get proper advice on exercises or ways to protect joints.
 SMS ‘HEALTH’ to 32212 with your question (cost is R1 per SMS) or e-mail questions to health@citizen. co.za

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