NGU treatment is a defined course of antibiotics. Current CDC guidance recommends doxycycline taken twice daily for a week over a single dose of azithromycin, a shift that reflects better cure rates and rising azithromycin resistance in Mycoplasma genitalium. Partners from the prior two months need treating too, or you'll reinfect each other CDC, 2021.
with the right treatment
testing, not symptoms, decides
| Item | Value |
|---|---|
| Curable? | yes — with the right treatment |
| Tested by | NAAT / lab |
| Often | no symptoms |
| If you may have it | get tested — testing, not symptoms, decides |
The essentials: what NGU actually is
NGU stands for nongonococcal urethritis — inflammation of the urethra (the tube that carries urine and semen out of the penis) that isn't caused by gonorrhea. It's a syndrome rather than a single infection, so treatment targets the likely culprits rather than one named germ.
Several organisms cause it. Chlamydia trachomatis is the most common identifiable cause, followed by Mycoplasma genitalium, a small bacterium that's increasingly hard to kill with older antibiotics. Less often, Trichomonas vaginalis (a parasite), herpes simplex virus, or adenovirus is responsible. In about half of cases no organism is found at all. The inflammation is real even when the lab swab comes back blank.
That uncertainty drives the treatment logic. Because chlamydia and M. genitalium are the heavy hitters and rapid testing for every cause isn't always available, clinicians treat presumptively for the most likely bacteria while the NAAT results come back.
Symptoms: what NGU feels like
NGU mainly shows up in men, and the classic trio is discharge, painful urination, and itching. The discharge can be mucoid (clear or cloudy and thin) or purulent (thicker and yellowish), and it's often most noticeable first thing in the morning before urinating.
- Urethral discharge that may be clear, cloudy, or thicker and yellow-tinged.
- Dysuria — a burning or stinging sensation when you pee.
- Itching or irritation inside the urethra, sometimes without obvious discharge.
- No symptoms at all in some infections, so screening still matters.
For a fuller breakdown of how this presents and what to watch for, see our guide to ngu symptoms in men. Because some infections are silent, the absence of symptoms doesn't rule out an STI you could pass on.
Testing: confirming urethritis before you treat
NGU is a clinical diagnosis that needs objective evidence of inflammation, not just a complaint. A clinician confirms urethritis in one of a few standard ways before labeling it NGU.
- A Gram stain of urethral secretions showing at least 2 white blood cells per oil-immersion field with no gonococci visible.
- A positive leukocyte esterase test on first-void urine, or at least 10 white blood cells per high-power field on that sample.
- NAAT (nucleic acid amplification testing) for chlamydia and gonorrhea on urine or a swab — and, in persistent cases, a NAAT for M. genitalium.
In practice this is easier than it sounds. Most diagnoses come from a urine cup or a quick self-collected swab plus a brief exam, and results are usually back within a few days. Health departments, Planned Parenthood, and Title X clinics offer this free or at low cost. If you're unsure whether enough time has passed since contact for a test to be accurate, read when to test after exposure before you go, and you can book a panel through get tested.
NGU treatment: doxycycline vs azithromycin
Current CDC guidance recommends doxycycline 100 mg orally twice daily for 7 days as the first-line treatment for NGU. The single-dose azithromycin 1 g that was once standard is now an alternative.
The shift comes down to resistance. Mycoplasma genitalium has developed widespread resistance to azithromycin, so single-dose azithromycin clears fewer of these infections than it used to. Doxycycline's week-long course produces better overall outcomes and slows the spread of resistance, and the guidelines have settled there for the long term.
| Regimen | How it's taken | Status | Key point |
|---|---|---|---|
| Doxycycline | 100 mg by mouth, twice daily for 7 days | Recommended (first-line) | Better outcomes; less azithromycin resistance pressure |
| Azithromycin | 1 g by mouth, single dose | Alternative | Convenient, but reduced reliability against M. genitalium |
Take the full course even after the burning and discharge fade. Stopping early leaves a partly treated infection that can rebound or breed resistance. Ask your clinician whether your partner needs treating in the same visit, because an untreated partner is the most common reason a clear-up doesn't stick.
Persistent or recurrent NGU
If symptoms come back or never fully resolve, don't simply repeat the same pills. Your clinician re-confirms that urethritis is actually present and tests specifically for M. genitalium. If that test is positive, the guideline-recommended approach is a course of doxycycline followed by moxifloxacin 400 mg daily for 7 days, a sequence chosen to overcome the resistance that defeated the first-line regimen.
Recurrence is also worth a candid conversation about reinfection from an untreated partner versus a resistant organism, since the fix differs.
Prevention and protecting partners
Refer all sex partners from the prior 60 days for evaluation, testing, and presumptive treatment effective against chlamydia. Treating partners stops the ping-pong cycle where you cure yourself and then catch it right back.
- Use condoms every time — consistent use lowers the risk of the sexually transmitted causes of NGU.
- Get partners from the past two months evaluated and treated, even if they feel fine.
- Schedule routine testing, which catches infections that cause no symptoms at all.
- Avoid sex until you and your partner have finished treatment, per your clinician's guidance, so you don't reinfect each other.
When to see a clinician
See a clinician promptly if you have discharge, burning with urination, or urethral itching — these warrant testing and, usually, presumptive treatment. Go back if symptoms persist or recur after you've finished the full course, which signals the need to re-confirm urethritis and test for M. genitalium.
A diagnosis here is common and treatable. Clinics handle NGU every day, treatment is a defined course, and it says nothing about you as a person. The only mistake is leaving it untreated.