Urinary Bacterial Flora of Women with Urethral Syndrome and Interstitial Cystitis

Abstract

The aerobic and anaerobic bacterial flora in the first voided and in the midstream urine of healthy females (n = 5) and female patients with either urethral syndrome (US) (n = 5) or interstitial cystitis (IC) (n = 14) were studied. Bacteria were grown on media enabling isolation of fastidious and aerobic as well as obligatory anaerobic species. In healthy females only gram-positive rods were found whereas US patients also harbored streptococci. Patients with IC presented also with Enterobacteriae and anaerobic bacteria. Five IC patients with severe symptoms were treated with metronidazole; 2 out of 3 patients with anaerobic bacteria in the pretreatment specimens had no anaerobes after metronidazole therapy and in 1 patient streptococci disappeared after the therapy. One patient with severe symptoms and Bacteroides fragilis in the midstream urine became symptom-free after 2 weeks of metronidazole treatment. Although there is uncertainty whether the US and IC are not related to an infectious etiology, the bacterial flora in urethral and in midstream urine in these conditions differs considerably from that of healthy females.

Alterations of microbiota in urine from women with interstitial cystitis

“…Haarala et al . (1999) [9] using culture techniques concluded that bacterial flora of midstream urine from patients with IC clearly differs from that of healthy women, in line with our findings. A study by Zhang et al .…”

“…Lactobacillus has not only been indicated or shown in IC urine samples from females (100% of the cases in this study and as shown by others [6,9,39]) but also demonstrated in IC urine from a male subject [41]. In our study we also detected a significant increase in abundance of this genus, considering its supposedly commensal presence in human urine from healthy subjects [16,18,19].…”

“…, Escherichia coli , Proteus mirabilis , Corynebacterium ssp., Klebsiella sp., Enterococcus sp ., Propionbacterium, Prevotella, Bacteroides sp. , and Peptostreptococcus [6,9,39]. Lactobacillus, Gardnerella and Streptococcus were repeatedly detected in these studies and were also seen in our study.…”

“…Investigators have used PCR, cloning and 16S ribosomal DNA (rDNA) sequencing to search for pathogenic agents in bladder biopsies and urine specimens of IC patients [6-11], but with conflicting results. However, some of these studies have indicated that women with IC may have a higher prevalence of bacteria in the urine than those without IC [6,8,9]. …”

Accuracy of urethral swab and urine analysis for the detection of Mycoplasma hominis and Ureaplasma urealyticum in women with lower urinary tract symptoms

“…Several studies show a weak correlation between the chronic urinary symptoms, i.e. LUTS and infections with Ureaplasma urealyticum, Mycoplasma hominis and anaerobic bacteria [4][5][6][7]. Although doxycycline treatment has been shown to be eVective in about 70% of women presenting with chronic urinary symptoms, a speciWc infectious organism could be identiWed in only 15% of the cases [7].…”