The diagnosis is based on the detection of an increased number of neutrophils in the smear from the urethra plus the clinical picture of urethritis or the re-detection of the increased number of neutrophils in the smear from the urethra. Before examination, the patient should not urinate for at least 4 hours.

Diagnostic criteria for urethritis:
detection of more than 5 neutrophils in the field of view with a 1000-fold increase in a Gram stain or a positive test for the determination of leukocyte esterase in urine sediment obtained by centrifugation of the first 30 ml urine
plus (1) anamnestic data on discharge from the urethra and itching in the urethra or (2) detection of discharge from the urethra during a clinical examination;
if an increased number of neutrophils in the smear from the urethra is detected in the absence of a clinical picture of urethritis, a repeated examination is shown after 5-7 days (the patient should not urinate at least 4 hours before the examination). Re-detection of an increased neutrophil count in a smear from a urethral drip confirms urethritis even in the absence of symptoms of the disease.

Persistent NGU
Persistent NGU may be due to Trichomonas vaginalis. Confirmation of urethritis by microscopy or determination of leukocyte esterase is necessary. With an increased number of leukocytes, a study on Trichomonas vaginalis is indicated. In case of severe pain during urination or other symptoms of genital herpes , a study for HSV is indicated.

Recurrent NSU
After treatment with chlamydial NSU, symptoms of urethritis occur again in 10-20% of cases; after treatment of non-chlamydial NSU in 20-40% of cases. Confirmation of urethritis by microscopy or determination of leukocyte esterase is necessary. Repeated studies on Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma genitalium and enterobacteria are usually negative and usually inappropriate. In the absence of an increased number of leukocytes in the discharge from the urethra, antibiotic therapy is not indicated.

Treatment of non-gonococcal urethritis

The first episode of NSU
Drugs of choice:
azithromycin, 1.0 g orally once;
doxycycline, 100 mg orally 2 times / day for 7 days.

Reserve drugs
erythromycin, 500 mg orally 4 times / day for 7 days;
ofloxacin, 300 mg orally 2 times / day for 7 days (prolonged ofloxacin – once 800 mg 1 time / day);
tetracycline, 500 mg orally 4 times / day for 7 days.

Persisting NSU
If trichomoniasis is suspected, metronidazole is indicated, 2.0 g orally once. If urethritis caused by HSV is suspected, antiviral drugs are indicated.

Relapsing NSU
At the first relapse of NSU (in the absence of reinfection) doxycycline is indicated, 100 mg orally 2 times / day for 7 days (if the first episode was treated with azithromycin or erythromycin) or erythromycin, 500 mg orally 4 times / day for 7 days ( if the first episode was treated with doxycycline or tetracycline). In subsequent relapses, many authors recommend ofloxacin, 300 mg orally 2 times / day (prolonged ofloxacin once 800 mg 1 time / day) or ciprofloxacin, 500 mg orally 2 times / day for 2-3 weeks (prolonged ciprofloxacin once 1000 mg 1 time / day). If symptoms persist, further antimicrobial therapy is not practical.

Prevention of non-gonococcal urethritis

At the first episode of NSU, an examination of sexual partners on Chlamydia trachomatis is necessary. Many authors recommend treatment for sexual partners during the first episode of non-chlamydial NSU. In relapses of NSU, repeated treatment of sexual partners is not indicated. For new and occasional sexual intercourse, use condoms.