Recurrent urinary tract infection in women

Car
and Sheikh¹ mentioned several causes of urinary frequency and pain on
micturition, but missed the most important one. In a prospective study of 50
women, who consulted me because of dysuria and/or frequency I found that all of
14 women with the urethral syndrome (dysuria without bacteriuria), 15/17 with
uncomplicated, lower urinary tract infection (dysuria with bacteriuri), but only
6/19 with asymptomatic bacteriuria used soap or other detergents on the sexual
organs regularly.²

     All women were advised to use water only and
women with urinary tract infection were treated with trimetoprim for three days.
At follow-up 22 of the 31 women with dysuria had stopped or substantially
reduced their use of soap. In seventeen dysuria had disappeared completely after
1-8 weeks, in particular a striking result for those with the urethral syndrome,
because many of these women had suffered from dysuria and frequency for several
years. In contrast, six out of seven who did not follow my advice had still
dysuria.

     Interestingly, six of the women with symptomatic
urinary tract infection, and who stopped using soap had recurrences, but these
recurrences were asymptomatic. Evidently, soap washing of the outer genitals
rather than bacteria seems to be the primary cause of dysuria. As there is no
evidence that asymptomatic bacteriuria in non-pregnant women has any adverse
health effects, the main treatment of dysuria, whether bacteriuria is present or
not, is to wash with water only. 

1. Car J, Sheikh A.
   Recurrent urinary tract infection in women. BMJ 2003;327:1204.
2. Ravnskov U. Soap is
   the major cause of dysuria. Lancet 1984;2:1027-8.

Competing interests:
None declared