RAPID RESPONSE FROM BMJ.COM

doi:10.1136/bmj.331.7517.E380

BMJ 2005;331:E380 (17 September), doi:10.1136/bmj.331.7517.E380

BMJ USA: Letter

Letter

RAPID RESPONSE FROM BMJ.COM

Following is an excerpt from Rapid Responses generated by thisarticle, all of which can be read in their entirety at http://bmj.bmjjournals.com/cgi/eletters/331/7509/143.—Editor

In my experience the most common cause of dysuria is soap. Thereforeit seems bad advice to treat this disorder with antibioticswithout further investigation, as suggested by Dr. Richardsand coworkers. In a prospective study of women who consultedme because of dysuria and/or frequency, I found that all of14 women with the urethral syndrome (dysuria without bacteriuria),15/17 with uncomplicated, lower urinary tract infection (dysuriawith bacteriuria), but only 6/19 with asymptomatic bacteriuriaused soap or other detergents on the sexual organs regularly.¹

All women were advised to use water only and women with a positiveurine culture were treated with trimethoprim for three days.At follow-up 22 of the 31 women with dysuria had stopped orsubstantially reduced their use of soap. In 17 dysuria had disappearedcompletely after one to eight weeks. In contrast, six out ofseven who did not follow my advice had still dysuria.

Interestingly, recurrences of bacteriuria were asymptomatic.Evidently, soap washing of the outer genitals rather than bacteriaseems to be the primary cause of dysuria. As there is no evidencethat asymptomatic bacteriuria in non-pregnant women has anyadverse health effects, a better treatment of dysuria, whetherbacteriuria is present or not, is to ask the women to wash withwater only.

Uffe Ravnskov, independent researcher

Magle Stora Kyrkogata 9, 22350 Lund, Sweden

Competing interests: None declared.