Urethral syndrome: Causes and consequences

Introduction. Urethral pain syndrome (UPS) is a little-studied issue.

Aim. To determine the role of intracellular infections in the UPS etiology and evaluate the efficacy of azithromycin in the treatment of UPS.

Materials and methods. A total of 18 female patients with UPS were included in the study. In addition to standard diagnostic procedures, urethra palpation and PCR examination of urethral discharge were performed. Quality of life was assessed using the SF-36 questionnaire filled out by the patients. Along with pathogenetic drugs, all patients received antibacterial therapy in the form of azithromycin (Azithromycin Express) according to the following scheme: 1.0 g as a single dose on Day 1, followed by 500 mg once daily for three days (the cycle dose is 2.5 g). The efficacy of treatment was estimated as a decrease in pain intensity after 7 days. The quality of life, pathogen eradication and pain intensity were assessed 2 months after completion of therapy. In addition, 73 domestic and foreign publications devoted to the issue of diagnosis and treatment of UPS were reviewed.

Results. On the day of presentation, Chlamydia trachomatis was detected in 5 patients, and Mycoplasma genitalium was detected in 12 patients. The leukocyte counts in urine averaged 12.7 ± 2.3. All patients had bacteriuria with a titer of 102–103 CFU/ml. The total pain intensity score averaged 7,2 ± 0,8. The quality of life scores measured by the SF-36 scale was 15.2 ± 1.7. After a week, the pain intensity decreased on average to 3.2 ± 1.7. During a follow-up examination after 2 months, C. trachomatis was not detected in the urethral scraping, and M. genitalium DNA was only detected in 1 patient. The pain intensity in the urethra averaged 1.4 ± 0.1. Therefore, the quality of life increased significantly (21.7 ± 0.9 scores).

Conclusion. The antibiotic prescription in UTS is justified. UTS cannot be considered an uncomplicated chlamydia infection, so we prescribed more than a single dose. Further research is needed to develop an optimal treatment regimen, including antibacterial one, for patients with UTS.

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