女性非淋病尿道炎易被長期誤診
許兆畬、殷約翰、戴浩平、陳祥來、謝肇新、黃鐘銘、翁瑋駿、黃立華、李毅彥、童敏哲
童綜合醫院 外科部 泌尿外科
Female non-gonorrhea urethritis - an entity of easy long term misdiagnosis and treatment
Chao-Yu Hsu, Jue-Hawn Yin, Hao-Ping Tai, Hsiang-Lai Chen, Siu-San Tse, Zhon-Min Huang, Wei-Chun Weng, Li-Hua Huang, I-Yen Lee, Min-Che Tung
Divisions of Urology, Department of Surgery, Tungs’ Taichung Metro Harbor Hospital, Taichung, Taiwan
Purpose: Urethritis, or inflammation of male urethra, is a group of common diseases and is easier for patients to call for help, and is also easier for doctors to diagnose and treat men with obvious symptoms and signs. Quite or just the opposite, female non-gonorrhea urethritis (NGU) is an entity of ambiguous symptoms and signs in women and make doctors to have time-consuming or misdiagnosis before a correct diagnosis and treatment.
Case Report: A 58 years old woman who received pubovaginal sling with TVT-O mesh about 6 years ago and did not get stress urinary incontinence thereafter. She suffered from painful voiding since two months ago and had long-term treatment as “recurrent urinary tract infection” at local clinics. At visiting, her maximum uroflow rate was 20 ml/sec with a continue flow pattern and only 46 ml post voiding residual urine. Cystofibroscopy only showed a mild congestive urethra without erosion of mesh. In spite of a negative chlamydia antigen test, we started doxycycline 100 mg q12h for 2 weeks and she attained a dramatic improvement of long term urinary tract symptoms.
Conclusion: Reviewed our patient’s history and literatures, 86% male patients versus 14% female patients had NGU in a cohort study, it showed these as a male predominant diseases. Clinical picture of the patients suffering from chlamydial infection could be missed, as up to 70~80% of the infected women and 50% of the infected men are free of symptom. Chlamydia trachomatis、Mycoplasma hominis and Ureaplasma Urealyticum are most prevalent offended species with 7.4~23% mixed pathogen organisms. Of difference, about 20-45% of urethritis patients were of negative culture report for pathogen organism. Doxycycline is the most common used antibiotics and was found to be effective in 89-90% cases of Ureaplasma Urealyticum urethritis.