I read with great interest the critical review article on diagnosing urinary tract infections (UTI), which was based on publications. It showed beautifully the dilemma posed by the diagnostic evaluation of UTI. Even in publications this is not optimal. Too often, the sole focus is on laboratory findings (pathogen numbers that are regarded as the gold standard for UTI) or test strips. The clinical picture with findings from the vulva and the urethral area, and microscopic urinalysis are often neglected. I can understand that subjective findings count less because clinical aspects are often ignored during medical training and their implication, especially in studies, is usually less accepted. Unfortunately, this often leads to a situation whereby it is bacteriological findings that are treated, not infections.
Dysuria may indicate more than a UTI—for example, vulvitis, dermatitis of the urethral exit, skin damage owing to exaggerated cleaning routines, or recurrent genital herpes. Infections are acute events and are accompanied by an inflammatory reaction—that is, a raised number of leukocytes in the urine. This can be identified immediately by means of a wet mount enlarged 400 times. More than 3 leukocytes in the visual field are suspicious. Unfortunately, the publications mention only the esterase test for detecting leukocytes, and to detect bacteria, only microscopy. Both are highly unspecific . Especially in women, the main group of patients with UTI, the vulva, the vaginal flora, and the number of leukocytes in the vaginal discharge have to be considered because they all contaminate urine.
Skin improvements in the anal area, the source of intestinal bacteria that cause UTI, is important.
Prof. Dr. med. Eiko E. Petersen
79117 Freiburg, Germany
|1.||Schmiemann G, Kniehl E, Gebhardt K, Matejczyk M, Hummers-Pradier E: The diagnosis of urinary tract infection: A systematic review. Dtsch Arztebl Int 2010; 107(21): 361–7 VOLLTEXT|