Recurrent urethral pain syndrome in a pregnant patient: a case for low-dose broad spectrum oral antibiotics

Abstract

Introduction As obstetricians, gynaecologists and urogynaecologists, anecdotally, we routinely see patients who complain of symptoms of urinary tract infections but have repeated clean catch urinary specimen remaining sterile, yet they respond positively to a short course of antibiotics. Sometimes, the response is sustained, on other occasions, the response is short-lived, but the response is usually satisfying to the patient. Surely, this cannot simply be the result of the known placebo effect. This paper makes a case for lowdose broad spectrum oral antibiotics in a pregnant patient with recurrent urethral pain syndrome. Case report We performed an extensive English language electronic search in the following databases: Medline, Embasse, Amed, Cinahl, Pubmed, Cochrane library and Trip; and did some search using the following search terms: urethral syndrome, urethral diseases in pregnancy, urologic diseases aetiology, presentation, treatment, outcome and therapeutics from 1951 to 2012. We found a paper by Baerheim and colleagues, who observed that there is equal symptomatic outcome after antibacterial treatment of acute lower urinary tract infection and the acute urethral syndrome in adult women. Their work did not include pregnant patients. Emboldened by the strength of the findings by Baerheim et al. and our observations in a case of a 24-yearold gravid female with recurrent episodes of urethral syndrome, which subsided when she was placed on low-dose oral co-amoxiclav, but rebounded leading to urinary retention when the antibiotic was discontinued; we make a case for low-dose oral antibiotics in a pregnant patient with recurrent urethral syndrome. Conclusion Since this is only a case report, it restricts us from making generalised statements, we would suggest that consideration be given to the use of broad-based antibiotics excreted by the kidneys in pregnant patients presenting with the urethral pain syndrome.