The Dysuria-Pyuria Syndrome

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Abstract
Most clinicians immediately suspect a diagnosis of bacterial cystitis in a woman who has dysuria and frequent urination but no clinical evidence of upper-urinary-tract infection. Yet studies from the United Kingdom1 2 3 and the United States4 show that 30 to 50 per cent of women seeking primary care for these symptoms do not have a positive urine culture according to the traditional criterion: isolation of a presumed pathogen, in pure culture, in concentrations of > 105 bacteria per milliliter of urine in a cleanvoided specimen. We have reported one reason for this phenomenon4: dysuria may often represent a vaginal, not . . .