Inﬂammation of the urethra that is not caused by gonorrhea (see previous page) is referred to as nongonococcal urethritis. It is the most common STD world- wide. About half of all cases of nongonococcal urethritis are a result of infec- tion with chlamydia (see page 183) or genital herpes (see page 183); the other half have no known cause.
Regardless of its origin, nongonococcal urethritis generally follows the same course: an incubation period of 2 to 3 weeks followed by a discharge from the penis, which may be clear or contain pus, and a burning sensation during urina- tion. When waking up in the morning, a man may ﬁnd the opening of his penis to be red and stuck together with dried secretions. If symptoms recur, they may be severe or mild.
While a doctor can usually diagnose chlamydia by examining the discharge from the penis under a microscope, more elaborate laboratory tests may be required to identify other microorganisms. Antibiotics can be effective against nongonococcal urethritis but are less effective when the speciﬁc microorganism causing the problem cannot be identiﬁed. The cure rate is roughly 85 percent. Because recurrences are common, follow-up visits to the doctor are necessary for 3 months after treatment. If the infection returns, drug treatment is repeated for a longer period. Ideally, a man’s sexual partners will be treated at the same time he is treated.
Left untreated, symptoms caused by chlamydia will most often disappear on their own in a month or so. However, the bacteria may cause epididymitis (painful swelling of the scrotum on one or both sides; see page 163).
Other complications of nongonococcal urethritis in men include prostatitis (inﬂammation of the prostate; see page 168) and urethral stricture (a narrowing of the urethra; see page 294). About 5 percent of men with nongonococcal ure- thritis develop Reiter’s syndrome, which is a combination of arthritis, urethritis, and sometimes conjunctivitis.