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Women with recurrent urinary tract infection (UTI) often demonstrate persistent vaginal colonization with Escherichia coli. Since strains of lactobacilli that produce hydrogen peroxide inhibit the growth of E. coli, the absence of these strains may predispose to E. coli colonization and to UTI. To test this hypothesis, vaginal introital cultures were obtained from 140 women, 65 with recurrent UTI (case-patients) and 75 without (controls). Vaginal E. coli colonization was significantly more frequent in case-patients than controls (35% vs. 11%; P < .001) and in women without H2O2-positive lactobacilli than in women with (odds ratio [OR], 4.0; P = .01). Spermicide use was associated with greater risk of vaginal E. coli colonization (OR, 12.5; P < .001) and with absence of H2O2-positive lactobacilli (OR, 2.9; P = .04). The inverse association between H2O2-positive lactobacilli and vaginal E. coli colonization remained in case-patients after controlling for spermicide use (OR, 6.5; P = .02). Thus, absence of H2O2-positive lactobacilli may be important in the pathogenesis of recurrent UTI by facilitating E. coli introital colonization.

The prevalence and duration of rectal and vaginal colonization with P- and F-fimbriated Escherichia coli and the relationship of colonization with these strains to blood group secretor status was investigated. Rectal and vaginal E. coli isolates were prospectively collected twice monthly for 6 months from 20 young women with and 20 without a history of recurrent urinary tract infection (UTI). Rectal and vaginal colonization with P- and/or F-fimbriated E. coli was highly prevalent. Nonsecretors who developed UTI during the study period were significantly more likely to be colonized rectally with F-fimbriated E. coli than were the infected secretors (56% vs. 27%; P = .042) or uninfected nonsecretors (56% vs. 31%; P = .046). Persistent vaginal and rectal E. coli colonization with fimbriated organisms occurred commonly in the study patients but was not often temporally associated with the development of UTI. Results suggest that nonsecretors are more susceptible than secretors to colonization with F adhesin-bearing E. coli isolates.

The symptoms, signs, and laboratory findings for 69 women who were seen at a sexually transmitted disease (STD) clinic and who had acute urinary tract infection (UTI) were compared with those for women who had vaginitis, gonorrhea, or chlamydial infection. Escherichia coli and Staphylococcus saprophyticus were the two most common causes of acute cystitis in this population and accounted for 62 (90%) of 69 infections. Forty-three percent of the women had positive tests for antibody-coated bacteria (ACB), an observation implying renal infection although symptoms of upper tract infection were infrequent. Frequency, urgency, dysuria, and suprapubic tenderness were significantly associated with cystitis, whereas vaginal discharge and vulvar itching were associated with vaginitis. There was, however, considerable overlap in symptoms among the four groups of women, and their accurate differentiation required objective information based upon pelvic examination, examination of vaginal fluid, and urinalysis. In the absence of vaginitis on wet mount and mucopurulent cervicitis on examination, pyuria, as determined by examination of centrifuged urine, had an 88% sensitivity, 76% specificity, 61% positive predictive value, and 93% negative predictive value for acute UTI. Because of the high prevalence of positive ACB tests and the possibility that infection with Chlamydia trachomatis and/or Neisseria gonorrhoeae may be mistaken for cystitis, we prefer a five- to seven-day course of antibiotics over single-dose therapy for treatment of patients with possible UTI in the setting of an STD clinic.