These recommendations are based on a UK National Guideline on the Management of non-gonococcal urethritis (NGU), published by the British Association for Sexual Health and HIV [BASHH, 2007], a European guideline [Shahmanesh et al, 2009], and a Canadian guideline [Public Health Agency of Canada, 2008].

History and examination

• Most men with urethritis will have a sexually transmitted infection (STI). It is important to assess the man's risk of STI, and if this is considered to be very low, an alternative cause for urethritis may be considered (for example prostatitis, irritation).

Testing for chlamydia and gonorrhoea

• Investigations are necessary to distinguish between infectious causes of urethritis as clinical features are unreliable [RCGP and BASHH, 2006].
• If chlamydia is suspected, a first-void urine sample should be sent for a nucleic acid amplification test (NAAT), as urine is obtained easily and more comfortably than a urethral swab [BASHH, 2004].
• The use of NAAT for gonorrhoea is complicated because of variable specificity between the commercial tests available, and concerns about the positive predictive value, particularly in low prevalence populations [HPA, 2009].
• If gonorrhoea is suspected, a urethral swab should be sent for culture and sensitivity testing [BASHH and HPA, 2010].
• Urethral swabs need to be sent to the laboratory promptly, otherwise the sensitivity of the test is markedly decreased [BASHH, 2004; BASHH, 2005].

Testing for urinary tract infection

• Urinary tract infections are unusual in young men. It is thought that up to 6% of non-gonococcal urethritis is caused by a urinary tract infection [Leung et al, 2002].