Lower genital tract infection in women

Urethritis

The urinary symptoms of lower genital tract infection in women include pain on passing urine, or frequency of passing urine. Sensitive methods for the laboratory diagnosis of C. trachomatis infection by the detection of chlamydial nucleic acid have made it abundantly clear that, in most cases of chlamydial cervicitis, there is also associated infection of the urethra . However it is unclear whether, in most cases, this is due to genuine chlamydial colonization or is simply contamination with chlamydial infected discharge from the cervix.

There is evidence C. trachomatis is one of the organisms thought to be associated with abacterial pyuria or the urethral syndrome [Mutlu et al., 2001]. Urethral syndrome is defined as 'symptoms suggestive of a lower tract urinary infection but in the absence of significant bacteriuria with a conventional pathogen' with three provisos concerning symptomatology and the definition of significant bacteriuria and conventional pathogens. The urethral syndrome is a very common condition; about half the patients visiting their General Practitioner by reason of frequency and/or dysuria do not have significant bacteriuria. Both infective causes (such as lactobacilli and sexually-transmitted pathogens) and non-infective causes (such as trauma, allergies, anatomical features, and co-existing medical conditions) have been suggested as causes [Hamilton-Miller, 1994]. Urethral C. trachomatis or Ureaplasma urealyticum infection can frequently be detected in patients with urethral syndrome [chronic dysuria and frequency] or with abacterial pyuria [Hare & Thin, 1983; Skerk et al., 2000]. suggesting that these organisms are involved in these conditions, although non-infectious factors, such as the sensitivity of the bladder epithelium to potassium, may also be important. In the consulting room it is often not possible to distinguish between acute urinary tract infection and the urethral syndrome, so such patients usually get treated with antibiotics anyway [Hamilton-Miller, 1994]. In general practice it has been reported that both acute urinary tract infection and acute urethral syndrome respond equally well to antibiotic therapy [Baerheim et al., 1999]. However where urethral symptoms last longer than 3 weeks, 6 doses of 500 mg of azithromycin was reported to be more effective than a single dose of 1 gram [Skerk et al., 2001]. For the CDC 2002 recommendations on the treatment of urethritis in both sexes see: male urethritis.

[MEW] Updated November 2002

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References

Baerheim, A., Digranes, A. & Hunskaar, S. (1999). Equal symptomatic outcome after antibacterial treatment of acute lower urinary tract infection and the acute urethral syndrome in adult women. Scandinavian Journal of Primary Health Care 17, 170 - 173.

CDC STI Treatment guidelines, May 2002 CDC Atlanta [For clinicians]

Hamilton-Miller, J. M. (1994). The urethral syndrome and its management. Journal of Antimicrobial Chemotherapy 33, Suppl A: 63 - 73.

Hare M.J. & Thin, R.N. (1983). Chlamydial infection of the lower genital tract of women. British Medical Bulletin 39, 138 - 144.

Mutlu, B., Mutlu, N. & Yucesoy G. (2001). The incidence of Chlamydia trachomatis in women with urethral syndrome. International Journal of Clinical Practice 55, 525 - 526. [Turkish study. Moderate association between urethral syndrome and chlamydial antigen detection. Low numbers].

Skerk, V., Barsic, B., Car, V., Schonwald, S. & Klinar, I. (2000). Comparative analysis of azithromycin and doxycycline efficacy in the treatment of female patients with acute urethral syndrome caused by Ureaplasma urealyticum. Journal of Chemotherapy 12, 186 - 188.

Skerk, V., Schonwald, S., Strapac, Z., Beus, A., Francetic, I., Krhen, I., Lesko, V. & Vukovic, J. (2001). Duration of clinical symptoms in female patients with acute urethral syndrome caused by Chlamydia trachomatis treated with azithromycin or doxycycline. Journal of Chemotherapy 13, 176 - 181.