Urethral syndrome in women attending an STD clinic.

Sir, We should like to comment on the article by Dr S K Panja in the June 1983 issue of the journal (pp 179-81). The urethral syndrome, or abacterial cystitis, has been defined as frequency of micturition and dysuria in the absence of bladder bacteriuria.' 2 These symptoms have been described in just over a fifth of women between the ages of 20 and 64 in one survey carried out in the United Kingdom.3 A causal role for C trachomatis in the urethral syndrome has recently been described.2 4 5 6 Dr Panja's study is an interesting addition to the literature, as it reports the prevalence of chlamydial infection in a group of women who attended a department of genitourinary medicine with frequency of micturition and dysuria. It is difficult to evaluate the 18% isolation rate of C trachomatis in the study, as the prevalence of this organism has ranged between 12% and 37% in women attending STD clinics.7 In a comprehensive study of the urethral syndrome, Stamm delineated three groups of patients, having excluded those with vaginitis (candidiasis, trichomoniasis, and clinical genital herpes simplex infection) and cystitis (>105 organisms/ml of urine) from further study.8 The remaining natients were subdivided into those with pyuria and low count coliform urinary infection, those with pyuria and N gonorrhoeae or C trachomatis, and those women with symptoms but no apparent pyuria or infectious aetiology. In Dr Panja's study, 38 patients would have been excluded from further consideration using Stamm's criteria. Since Stamm suggests that low count coliform infection may -ontribute to the urethral syndrome, it is mpossible to comment on the role of C frachomatis in the present study without :his additional information. Hare and Thin suggest a causal role for C 'rachomatis in the urethral syndrome.4 A )rospective long term study, with sufficient :ases and controls, looking into the tetiology of this debilitating yet common condition is required with reference to patients and their male partners. Yours faithfully, G Forster PEMunday The Praed Street Clinic, St Mary's Hospital, Praed Street, London W2 lNY