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As in many other studies of urinary tract infection, Holm et al. found that many women with dysuria do not have bacteriuria.1 The reason is most likely the use of soap. In a study of 50 women with frequent uncomplicated urinary tract infections, dysuria without bacteriuria, or asymptomatic bacteriuria, 27 of 31 among those with dysuria washed their sexual organs with soap every day, but only one among 19 with asymptomatic bacteriuria. Furthermore, dysuria disappeared in almost all of those who stopped using soap.2 Obviously, women with dysuria should be warned against using soap because dysuria occurring after previous treatments of cystitis may be interpreted as a sign of recurrence of the infection and result in unnecessary treatment.
1. Holm A, Siersma V, Cordoba GC. Diagnosis of urinary tract infection based on symptoms: how are likelihood ratios affected by age? a diagnostic accuracy study. BMJ Open 2021;11:e039871. doi:10.1136/ bmjopen-2020-039871
2. Ravnskov U. Soap is the major cause of dysuria. Lancet 1984;1(8384):1027-8. doi: 10.1016/s0140-6736(84)92381-x.