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ESSIC uses the name bladder pain syndrome (BPS) instead of interstitial cystitis (IC) and/or painful bladder syndrome (PBS): 
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  • Dysuria at onset of interstitial cystitis/painful bladder syndrome in women
    Warren JW, Diggs C, Brown V, et al. Urology 2006;68:477-81
    • a slight majority of women with IC/PBS reported dysuria at onset of their IC/PBS symptoms 
    • the available laboratory data have suggested that dysuria may be a sensitive indicator of urinary tract infection at the onset of IC/PBS; however, its specificity is as yet undetermined

  • There is a low incidence of recurrent bacteriuria in painful bladder syndrome/interstitial cystitis patients followed longitudinally.  
    Stanford E, McMurphy C. Int Urogynecol J Pelvic Floor Dysfunct 2007;18:551-4  
    • this study showed a low incidence of urinary tract infections (UTI) in PBS/IC patients 
    • the data suggest that only a small number of PBS/IC patients with UTI symptoms have positive urine cultures (9.4%; 10/106) and that the incidence of confirmed recurrent UTIs is only 6.6% 
    • the flares of PBS/IC were usually self-limiting and treatment response to antibiotics may be misleading in light of the low incidence of positive urine cultures 
    • the data suggest that the symptom flares of PBS/IC are not usually associated with recurrent UTI and, therefore, are likely due to a triggering of the other painful mechanisms involved in PBS/IC patients who are culture-negative.

  • Absence of bacterial and viral DNA in bladder biopsies from patients with interstitial cystitis/chronic pelvic pain syndrome
    Al-Hadithi HN, Williams H, Hart CA, et al. J Urol 2005;174:151-4  
    • bladder biopsies were taken during cystoscopy from patients under investigation for IC/CPPS, or controls undergoing colposuspension for stress incontinence; PCR for bacterial and viral gene sequences was performed using specific primers  
    • 92 patients with IC/CPPS (12 met the NIDDK criteria) and 91 controls were recruited 
    • PCR for the 16S ribosomal RNA gene, as well as for adenovirus, cytomegalovirus, herpes simplex virus types I and II, human papillomavirus (all subtypes) and Chlamydia trachomatis were negative in all samples. • the authors conclude that IC/CPPS is not associated with persistence of viral and bacterial DNA in the bladder

  • Association of chronic urinary symptoms in women and Ureaplasma urealyticum
    Potts JM, Ward AM, Rackley RR. Urology 2000;55:486-9
    • the authors conclude that although often overlooked or improperly treated, Ureaplasma urealyticum and Mycoplasma hominis infections may account for a large proportion of unexplained chronic voiding symptoms
    • culture and treatment should be considered before pursuing more costly and invasive tests

  • Pilot study of sequential oral antibiotics for the treatment of interstitial cystitis
    Warren JW, Horne LM, Hebel JR, et al. J Urol 2000;163:1685-8
    • 50 patients with IC were randomized to receive 18 weeks of placebo or antibiotics, including rifampin plus a sequence of doxycycline, erythromycin, metronidazole, clindamycin, amoxicillin and ciprofloxacin for 3 weeks each 
    • 12 of 25 patients (48%) in the antibiotic and 6 of 25 (24%) in the placebo group reported overall improvement (p = 0.14), while 10 and 5, respectively, noticed improvement in pain and urgency (p = 0.22) 
    • in the antibiotic group 20 participants (80%) had adverse effects compared with 10 (40%) in the placebo group (p = 0.009) 
    • the authors conclude that their findings suggest that these antibiotics alone or in combination may sometimes be associated with decreased symptoms in some patients but they do not represent a major advance in therapy for interstitial cystitis 

  • Urinary bacterial flora of women with urethral syndrome and interstitial cystitis.
    Haarala M, Kiilholma P, Lehtonen OP. Gynecol Obstet Invest 1999;47:42-4 
    • The aerobic and anaerobic bacterial flora in the urine of healthy females (n = 5) and female patients with either urethral syndrome (US) (n = 5) or interstitial cystitis (IC) (n = 14) were studied 
    • in healthy females only gram-positive rods were found whereas patients with IC presented also with Enterobacteriae and anaerobic bacteria  
    • 5 IC patients with severe symptoms were treated with metronidazole; 2 out of 3 patients with anaerobic bacteria in the pretreatment specimens had no anaerobes after metronidazole therapy and in 1 patient streptococci disappeared after the therapy; one patient with severe symptoms and Bacteroides fragilis in the midstream urine became symptom-free after 2 weeks of metronidazole treatment 
    • the authors conclude that although there is uncertainty whether the US and IC are not related to an infectious etiology, the bacterial flora in urethral and in midstream urine in these conditions differs considerably from that of healthy females 

  • Detection of eubacteria in interstitial cystitis by 16S rDNA amplification.  
    Heritz DM, Lacroix JM, Batra SD, et al. J Urol 1997;158:2291-5 
    • 30 patients with IC and 16 control patients with culture negative urine underwent bladder biopsy
    • PCR using two sets of universal primers for bacterial 16S rDNA was performed on urine from the cystoscope and on a cold cup bladder biopsy specimen; of the PCR positive bladder biopsies, 3 patients with IC and 3 controls were randomly selected and cloned; 10 clones from each were sequenced and putative taxonomic assignments made 
    • 12/26 (46%) IC and 5/12 (42%) control urine specimens and 16/30 (53%) and 9/15 (60%) bladder biopsies were PCR positive, respectively; the bacterial populations in the 2 patient groups tested appeared to be different based upon analysis of the 16S rRNA sequences  
    • the authors conclude that both IC and control patients had non-culturable bacteria in their bladders; a random sampling of the two populations revealed that the bacterial populations are different, suggesting a possible link between one or more bacterial species and IC

CONFUSABLE DISEASES - Intestinal Bacteria

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