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Abstract
Neisseria gonorrhoeae , although not found in this study, may have a more important role in other population groups.7 In a patient with persistent dysuria in sterile cultures, "interstitial cystitis" should be considered; this unusual disorder of unknown cause can be diagnosed by cystoscopy.8 The role of other bacterial and viral agents in the patients in the Seattle study with apparently sterile urine and no pyuria remains speculative, but it is interesting that two patients in this "uninfected" group had genital herpes simplex. [...]the Seattle workers found that women with dysuria and frequent urination but without clinical evidence of pyelonephritis could be divided into four groups: three groups with potentially treatable infections -- those with >105 bacteria ("cystitis"), those with <105 bacteria, and those with chlamydial infection -- and one group with no recognized cause. According to our studies, "external dysuria" (pain felt in the inflamed vaginal labia as a stream of urine passes) suggests vaginal infection, and "internal dysuria" (pain felt to be inside the body) suggests urinary-tract infection.4 One should ask whether a recent sexual partner has had urethral discharge or dysuria; if so, a culture for gonorrhea might be more helpful and chlamydial infection more likely. According to the Seattle study, a recent new sexual partner and a longer duration of symptoms appear to indicate chlamydial infection, whereas a history of hematuria and of sudden onset of symptoms seems to indicate lowcount bacterial infection.