Dysuria - Abacteriuric frequency or urethral syndrome

Causes of truly abacteriuric frequency/dysuria include postcoital bladder trauma, vaginitis, atrophic vaginitis or urethritis in the elderly, and interstitial cystitis (Hunner's ulcer).

In symptomatic young women with 'sterile pyuria', Chlamydia infection and tuberculosis must be excluded.

Interstitial cystitis is an uncommon but distressing complaint, most often affecting women over the age of 40 years. It presents with frequency, dysuria and often severe suprapubic pain.

Urine cultures are sterile. Cystoscopy shows typical inflammatory changes with ulceration of the bladder base.

The cause is unclear but it is commonly thought to be an autoimmune disorder. Various treatments are advocated with variable success. These include oral prednisolone therapy, bladder instillation of sodium cromoglicate and bladder stretching under anaesthesia.

Careful history-taking will identify a group with predominant frequency and passage of small volumes of urine who have 'irritable bladders', possibly consequent on previous UTI or conditioned by psychosexual factors. Such patients must be distinguished from those with frequency due to polyuria.

Repeated courses of antibiotics in patients with genuine abacteriuric frequency or dysuria are quite inappropriate and detract from identifying the true nature of the problem.