Cystitis and urethritis.

Abstract

CLASSIFICATION Although the terms cystitis, urethritis, and pyelonephritis are useful to the clinician for describing different clinically encountered varieties of urinary tract infection, one must not be limited only to site of localization when classifying urinary infections. Two other helpful schemes of classification (Table 1) have evolved based on pathogenesis1 and management.2 FREQUENCY OF OCCURRENCE Children and adolescents with cystitis or urethritis have urinary symptoms suggestive of urinary tract infection. In fact, not all symptomatic patients have true bacteriuria. Of all patients less than 15 years of age with urinary symptoms, only 9% were bacteriuric, and only 18% with dysuria had positive cultures for a pathogen.3 The incidence of true urinary tract infection from these data is 1.7 per 1,000 boys and 3.1 per 1,000 girls per year. The incidence of apparent first symptomatic urinary tract infection declines with increasing age, the decline being more rapid in boys (Figure). Patients with nonsymptomatic infections often feel more comfortable after treatment or more commonly may report loss of characteristic odor after appropriate therapy has been initiated for the positive culture results obtained for surveillance purposes. Data from large screening surveys of so-called healthy populations demonstrate a prevalence of unrecognized bacteriuria in 0.5% to 1.6% of school-aged girls.