Non-Specific Urethritis in Women

Non-specific urethritis goes by a number of different monikers, including NSU and NGU (non-gonococcal urethritis), and is a condition that has become a growing concern amongst the medical community as it is often linked to sexually transmitted infections. In this article we look at NSU in women as the condition is experienced differently by the sexes due to biological differences in the structure and functions of the urethra and reproductive system.

Causes of NSU in women

Women in the UK are thought to suffer NSU as a result of sexually transmitted infections (STI) or injury to the urethra. The urethra is the structure affected by the condition and from which the illness draws its name. This structure is a tube which runs from the bladder and out of the body, and in NSU it becomes inflamed as part of an immune response (the actions of our body’s natural defences) to infection or injury.


About 40% of cases of NSU are thought to be caused by chlamydia infections. Chlamydia is a relatively common sexually transmitted disease which spreads through unprotected sexual contact be it vaginal, oral, or anal.

While a large portion of infectious cases of NSU in women are thought to be a consequence of chlamydia, there are a host of other bacteria which may reside in the mouth, throat, or anus which can cause non-specific urethritis. These bacteria are usually harmless in their usual environment, and only cause harm once within the urethra. Examples of these bacteria include Mycoplasma and Trichomonas Vaginalis.

Viruses can also potentially cause an inflammation of the urethra in women, although cases of NSU caused by viral infection are less common than in men. The adenovirus, which will typically cause a sore throat, or the herpes virus are good examples of viral causes of urethritis.

In some instances NSU is caused by injury or exposure to irritant materials. A chemical product like a soap or cream used near the genitals can potentially cause the urethra to inflame, which is why it is always important that both men and women take care when applying any material to their genitals. Injury, most commonly through the insertion of a catheter, can also cause an inflammatory response and trigger NSU. Catheters are tubes which are lubricated and then run up the urethra and into the bladder to provide relief for people who might not be able to urinate normally for medical reasons. While care is taken in the application of catheters and a lubricant is used, their placement an cause urethritis.

Symptoms of NSU in women

Interestingly while most men will experience symptoms like a burning during urination or a discharge from the end of the penis, women very rarely demonstrate any symptoms or signs of non-specific urethritis. The condition is quite insidious in this respect as without any symptoms it is often left untreated, and can develop into a far more serious condition. If caused by a sexually transmitted infection, then the fact that NSU has no symptoms can lead to the unwitting transmission of the STI.

Prognosis and Treatment of NSU in Women

If left untreated, a severe cause of non-specific urethritis can develop into a pelvic inflammatory disorder, a condition with more serious implications for women. Men don’t develop PID, and in most cases NSU in men will resolve even without treatment. Because of how serious PID can be in women, diagnosing and treating NSU quickly and effectively is extremely important.

PID occurs when the infectious agent causing NSU spreads to the rest of the reproductive tract, including important and sensitive structures like the uterus or fallopian tubes (which link the uterus to the ovaries). Ultimately untreated PID can affect a woman’s fertility and cause what are known as ectopic pregnancies. An ectopic pregnancy is when a fertilised egg implants in an abnormal location rather than the womb, most commonly the fallopian tubes.

Other complications of untreated NSU include persistent NSU, a condition where the inflammation of the urethra recurs regularly. If your symptoms recur following treatment, you are likely to suffer from persistent NSU and should consult your doctor for further testing and treatment. Persistent NSU is rarer in women than in men, but it does occur.

Reiter’s syndrome is also an extremely rare complication of NSU which may affect about 1% of sufferers. The condition is also described as reactive arthritis, and occurs when the body’s immune system chooses to attack its own, healthy cells rather than the infectious agent causing NSU. This type of faulty action is called an autoimmune condition, and is thought to be a result of a confusion in the immune system’s ability to perceive and identify ‘self’ and foreign materials. Reiter’s syndrome can cause pain in the joints, conjunctivitis, and recurring urethral inflammation.

The treatment of NSU in women is exactly as it would be amongst men and usually involves the administration of one of two first line antibiotic treatments. Doxycycline is given as a weekly regimen of 2 doses a day, while azithromycin is administered as a single dose you only need to take once. If your symptoms don’t clear up within 2-3 weeks of treatment (if you are experiencing any symptoms that is), then your doctor will usually run more tests and switch to alternative treatments.

While the condition shares some distinctive similarities in both men and women, there are fundamental differences in how the disease can be experienced by the sexes, and in the complications it can cause if left untreated. Because women rarely experience symptoms and the untreated infection can cause serious complications, it is important that unprotected sex with multiple partners be avoided as this hugely increases the risk of STI based NSU.

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