, Volume 6, Issue 4, pp 195-197

The female urethral syndrome is rarely associated with human papillomavirus infection types 6/11, 16, 18, 31, 33

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In a 24-month prospective study, 22 patients with documented papillomavirus lesions elsewhere in the lower genital tract underwent biopsy of the urothelium of the urethra. These patients met the accepted criteria for urethral syndrome. The specimens were obtained under colposcopic control with small tissue biopsy forceps inserted through a modified Kelly air cystoscope. Polymerase chain reaction amplification and subsequent DNA primer evaluation failed to reveal the presence of papillomavirus infection in 20 of the 22 patients. Differentiated squamous mucosa was found on morphologic studies from these biopsies in 18 instances (82%). This multicenter study was unable to document the presence of human papillomavirus infection of the proximal urethral vesical neck or bladder trigone.

Editorial Comment: When one sees a patient with urinary frequency, dysuria, urgency, suprapubic discomfort, dyspareunia, urethral pain and voiding difficulty, a number of causes come to mind. One of these is the urethral syndrome, which can be associated with some or all of the above and has been termed a ‘wastebasket’ diagnosis. This paper gives us one more exclusionary factor when considering a patient with such a symptom complex. The diagnosis of urethral syndrome should be strictly one of exclusion, much as postmenopausal bleeding attributed to atrophic vaginitis is a diagnosis of exclusion. All of the common urinary pathogens and sexually transmitted diseases that can cause infection and all causes of inflammation need to be excluded before the diagnosis of urethral syndrome is entertained. This paper shows that, in all probability, the cause of this syndrome is not related to the human papillomavirus, at least for the types tested for in this present communication.