Nongonococcal urethritis (NGU) is a urethral infection in men that is sexually transmitted and is not caused by gonorrhea. It can be caused by several organisms, including Chlamydia trachomatis (in 23-55% of men with NGU), Ureaplasma urealyticum (20-40%), and Trichomonas vaginalis (2-5%). It can also, rarely, be caused by the herpes simplex virus, as well as other bacteria or viruses. (See the sections on chlamydia infection, trichomonas infection, and herpes for more information.) Men who perform anal sex on partners may develop urethral infections from the bacteria that are normally found in stool. NGU, therefore, is not a specific “bug,” but rather a syndrome with several possible causes. Before many of the specific organisms that cause this infection were identified, it was also known as nonspecific urethritis.

HOW COMMON IS IT? NGU is the most common problem for which men seek help in sexually transmitted disease clinics. It is estimated that four to six million men in the United States are infected with NGU each year. Men of any age can become infected, although NGU is most often diagnosed in younger men (those in their teens to twenties) who are more sexually active and less likely to be following safer sex practices. A man can be infected and not know it.

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An initial herpes infection can occur in the anal and rectal area, most often after having received anal sex. This infection usually causes rectal pain and discharge, which may be bloody, and it can also cause fever, muscle aches, and changes in bowel movements. Recurrences of outbreaks can occur in the rectal area. Although HSV outbreaks inside the rectum usually occur as a result of receptive anal intercourse, herpes outbreaks can occur around the anal area even in someone who has other STDs also cause sores in the never received anal sex, because the nerve that supplies that area also supplies the genital area.

Herpes infections can cause more serious symptoms. For example, genital herpes outbreaks can cause inflammation of the lining of the spinal cord, called meningitis. Meningitis caused by herpes is a type of viral meningitis that is different from the often life-threatening bacterial meningitis. Signs of this infection are a stiff neck and pain in the eyes when looking at light. Most people who have a first infection with genital herpes have some inflammation of the spinal fluid, since the virus is in a nerve, but only a small percentage develop symptoms from this inflammation. For a very few people, the only symptom of recurrent herpes outbreaks is viral meningitis. Meningitis from herpes infections seldom causes any permanent problems, but it may recur, either with or without subsequent outbreaks.

Oral herpes infections can cause inflammation of the tissues of the brain, called encephalitis. Signs of this infection are headache, fever, confusion, seizures, and neurological impairment, depending on which area of the brain is affected. Encephalitis can result in permanent neurological symptoms. However, considering how common oral herpes infections are, this is a very uncommon complication.

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As already mentioned, the causative organisms of prostate infection may or may not be sexually transmitted. Oral, genital, or anal intercourse can cause infection with bacteria such as those responsible for gonorrhea and chlamydia if a partner is infected, whether or not he or she is symptomatic. Performing anal sex on a partner also increases the risk of infection of the prostate with the bacteria commonly found in stool. Condoms—if they are used consistently and correctly and they do not leak or break—will prevent the transmission of these bacteria.

Prostate infections that are older and who have some predisposing structural cause, such as enlargement of the prostate. Common misconceptions are that prostate infection is caused by sitting too long, by not having sex frequently enough, or by various dietary problems. All of these statements are not true.

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If your partner is uncomfortable or is not ready to talk about sex, let him or her know that you understand that these are difficult topics to discuss, and that whenever he or she is ready to talk about them, you are ready to talk, too. But let your partner know that you don’t want to have sex until you have had this discussion.

When you and your partner do have the discussion, keep in mind that what you want is a dialogue, in which both of you can express your feelings on these topics. Blanket or judgmental statements—such as “Everyone who has sex without a condom is stupid”—rarely lead to an open discussion. Try to be honest about your own thoughts and goals. Don’t say things to impress your partner. Use “I” statements (such as “I would like to use a condom”); they allow you to express your feelings openly and clearly. Then you can ask your partner about his or her feelings, using open-ended questions such as “What are your thoughts?” If you are having this conversation, the odds are that both you and your partner have been thinking about these issues and want to find out specific information about each other. Answering the questions listed here will provide the information that you will want to have before beginning a new sexual relationship. It is important to be honest. Intentionally misleading your partner will only weaken the foundation upon which your relationship is based.

Rather than reading the questions off like a laundry list, or interrogating your partner in a way that makes him or her uncomfortable, you may want to cover these topics in the course of your conversation. However you and your partner go about discussing these subjects, you should plan to get answers to the following questions:

1. How many sexual partners have you had in the past?

2. Have you had any partners of the same sex?

3. Have you ever had unprotected sex with a partner?

4. Have you ever used injection drugs? Did you ever share needles?

5. Have you ever received a transfusion of blood or blood products? (The U.S. blood supply began to be screened for HIV in 1985; the risk of acquiring HIV infection from blood transfused since 1985 is very low.)

6. Have you ever been tested for sexually transmitted infections?

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There’s not a lot of good information on this subject, but some studies have indicated that farmers and mechanics may have a higher risk of prostate cancer. It’s hard to know what to do with information from such studies, however; it’s very difficult to separate what people do from who they are—their family history, their diet and habits. For example, do farmers and mechanics have more fat in their diets than others? Do they smoke more? One case-control study found that 75 percent of 40 patients with prostate cancer had a history of farming compared with 37.5 percent of control patients with BPH. (On the other hand, it could be argued that these older men were products of a generation that was much more agrarian. Who knows?)

Other studies have indicated that cadmium, a trace mineral present in cigarette smoke and alkaline batteries, may have something to do with prostate cancer. Men who are welders or who work in electroplating, over time, get exposed to high levels of cadmium; these studies suggest that cadmium exposure marginally increases a man’s risk of developing prostate cancer. One explanation may be that cadmium somehow interferes with zinc, a necessary element in many of the body’s activities—and men with prostate cancer have been found to have lower levels of zinc in their prostates than other men.

What does it all mean? If you’re a farmer, or a mechanic, newspaper worker, plumber, welder, or worker in a rubber-producing factory (all of these have been suggested, without much proof, as occupations that raise a man’s risk of getting prostate cancer), don’t be alarmed. There’s no evidence to indicate that you should.

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