Causes of the Acute Urethral Syndrome in Women

Abstract

To determine the cause of the acute urethral syndrome, we studied 59 women with dysuria and frequent urination without "significant bacteriuria" (defined as greater than or equal to 10(5) organisms per milliliter), 35 women with typical cystitis and 66 women with no symptoms of urinary-tract infection. Although none of the 59 women with urethral syndrome had greater than 3.4 x 10(4) bacteria per milliliter in either of two successive midstream urine specimens, samples of bladder urine obtained by suprapubic aspiration or catheterization from 24 women contained coliforms, and samples from three contained Staphylococcus saprophyticus; all but one of these 27 women also had pyuria. Of the 32 women with sterile bladder urine, 10 of 16 with pyuria and one of 16 without pyuria were infected with Chlamydia trachomatis (P = 0.002). Chlamydial infection was found in 11 of 42 women with urethral syndrome and pyuria, in three of 66 without symptoms, and in one of 35 with cystitis (P less than 0.01 when the group with urethral syndrome is compared with either of the other groups). Thus, 42 of 59 women with urethral syndrome had abnormal pyuria and 37 of these 42 were infected with coliforms, S. saprophyticus, or C. trachomatis, whereas few women without pyuria had demonstrable infection. Bacteriuria of greater than or equal to 10(5) per milliliter may be an insensitive diagnostic criterion when applied to symptomatic lower-urinary-tract infection.

Urinary Symptoms in Adolescent Females: STI or UTI?

“…[7]' [11] While symptoms did not predict outcomes, we showed that urinalysis results of leukocytes or blood predicted STI, while nitrites or protein predicted UTI in symptomatic patients. In a classic study of women with acute urethral syndrome, sterile pyuria (defined as a negative urine culture and positive urine leukocytes) was strongly associated with CT. [12] However, we found that sterile pyuria was more commonly associated with TV and GC instead of the CT that we expected. Finally, in women with urinary symptoms, we found a higher prevalence of TV in those without a UTI compared to those with a UTI.…”

Recurrent Urinary Tract Infections Management in Women : A Review = الإلتهابات المتكررة للمسالك البولية عند النساء و طرق علاجها : مراجعة

“…7,8,21 Irritative voiding symptoms are present in 25-30 % of women with RUTIs. 25 The probability of finding a positive culture in the presence of the above symptoms and the absence of vaginal discharge is around 81%. 26 In a complicated UTI, such as pyelonephritis, the symptoms of a lower UTI will persist for more than a week with systemic symptoms of persistent fever, chills, nausea and saprophyticus lack that enzyme, which makes the nitrite test considerably less useful.…”

“…Skin allergens introduced to the genital area, such as bubble bath liquids, bath oils, vaginal creams and lotions, deodorant sprays or soaps are better avoided as they could alter vaginal flora and vomiting. 25 A recent study showed how to distinguish the clinical symptoms of a RUTI from irritative voiding symptoms (urgency, dysuria and frequency) without infection. Women with RUTIs were more likely to experience symptoms after intercourse, have a previous history of pyelonephritis, and experience rapid resolution of symptoms postantibiotic therapy than those women with irritative voiding symptoms.…”

Overdiagnosis of Urinary Tract Infection and Underdiagnosis of Sexually Transmitted Infection in Adult Women Presenting to an Emergency Department

“…Lower UTIs and many STIs have overlapping symptomatology, including the traditional UTI symptoms of dysuria, frequency, and urgency. In addition, abnormal urinalysis (UA) findings of positive leukocyte esterase and pyuria are common in both UTIs and STIs (3)(4)(5)(6). Thus, distinguishing between these infections can be challenging.…”