BERKELEY, CA (UroToday Inc.) - Persistent urinary urgency and frequency and chronic urethral and/or pelvic pain in women are often a diagnostic and therapeutic challenge that can be frustrating for patients and physicians. Frequently, the search for a causative infectious agent proves futile and after multiple ineffective treatment regimens the patient may be classified as having interstitial cystitis or referred to a psychiatrist as the last option. Doxycycline is a broad-spectrum antibiotic that is effective against microorganisms which are not detected by routine urinary cultures, such as Chlamydia trachomatis, ureaplasma urealyticum and mycoplasma genitalium.

F.C Burkhard et al., from Berne, Switzerland evaluated the use of doxycycline for the treatment of these urinary conditions in this difficult patient population. Their results are reported in the July 2004 issue of The Journal of Urology. They evaluated a total of 103 women presenting with a history of urinary urgency and frequency, and chronic urethral and/or pelvic pain often associated with dyspareunia and/or a history of recurrent urinary tract infection.

Initial examinations included a clinical history, cervical/vaginal swabs, serum analysis for infectious organisms such as chlamydia, urine examination and culture, bladder barbitage, and cystoscopy. All patients also underwent a renal and bladder ultrasound to confirm bladder emptying. Patients were treated with 100 mg of doxycycline twice daily for 2 weeks followed by once daily for an additional 2 weeks. Women also received vaginal antimicrobials (ciclopiroxolamine or hexetidine) once daily for 10 days. The sexual partner was also treated with 100 mg of doxycycline twice daily for 2 weeks and instructed to use condoms during the 4 week study period.

The endpoint of the study was a subjective sensation of cured or improved versus no improvement in symptoms. A detailed clinical history was again performed at the conclusion of the study period and a subset of patients underwent a repeat cystoscopic evaluation. Analysis showed that all patients were found to have endoscopic trigonal leukoplakia pre-treatment yet only 15% were found to have a detectable microbiologic pathogen. Mean age of the patient population was 46 years with a mean symptom duration of 60 months. Mean follow-up was 3 months. Following treatment with doxycycline, 31 of the 103 women (30%) considered themselves cured and 42 (41%) reported subjective improvement. Of the 103 patients, 29 (28%) showed no change while 1 patient considered herself to be worse. Thirty patients consented to a follow-up cystoscopic evaluation, which showed resolution of trigonal leukoplakia in 26% or improvement in 39%.

The authors hypothesize that the presence of trigonal leukoplakia is a sign of underlying chronic infection and its appearance is helpful in decision-making regarding treatment. With a 70% chance of cure or improvement with doxycycline, the authors consider the treatment to be an acceptable option which should be administered before stigmatizing the patient with a diagnosis of interstitial cystitis or referring her to a psychiatrist.

J Urol. 2004;172(1):232-5