NE-AUA 2006 Annual Meeting, September 28 - 30, 2006, The Westin Hotel & Rhode Island Convention Center Providence, Rhode Island
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Strep and Urinary Frequency: Is There a Connection?
Christina Kim, MD1, Steven G. Docimo, MD2, Kathleen McKay, PhD1.

1Connecticut Children's Medical Center, Hartford, CT, USA, 2University of Pittsburgh, Pittsburgh, PA,

Abstract: Pediatric autoimmune neuropsychiatric disorder associated with group A streptococcal infection (PANDAS) is a recently described entity. PANDAS presents with sudden onset of obsessive-compulsive or tic behavior shortly after a Group A beta-hemolytic streptococcal (GABHS) infection.
In a prior study, the majority of PANDAS patients presented with sudden onset of urinary urgency and frequency. Although there was no urinary infection, patients were treated with antibiotics for their GABHS infection. After completion of antibiotics, patients had dramatic and rapid resolution of their symptoms.
Idiopathic urinary frequency (IUF) is characterized by sudden onset of urinary frequency with no instigating factor.
This case series evaluated patients with IUF who were screened with a throat culture for Streptococcal pharangitis.
Materials and Methods: A total of 41 patients with IUR were seen in a single pediatric urology practice from August 2002 through March 2004. Urinary tract infection was ruled out by urinanalysis or urine culture.
Each patient underwent a throat swab culture to screen for Streptococcal infection. All patients with a positive throat culture received 1-2 weeks of oral antibiotics.
A telephone interview was used to assess their clinical course.
Our goal was to assess any difference in resolution of symptoms for patients who had positive versus negative throat cultures.
Results: A total of 41 patients were diagnosed with IUF and underwent a Streptococcal throat culture. Fourteen patients (group A) had positive Streptococcal throat cultures at the time of their urologic evaluation. Eight patients (group B) had initially negative throat cultures, but later had a positive throat culture when evaluated by their PCP. Nineteen patients (group C) had negative throat cultures at initial visit and at later assessment by their PCP.
Mean time to resolution for group A was 3.8 months, group B was 8.4 months, and group C was 5.79 months. Therefore, the quickest time to resolution was seen in patients with initially positive throat cultures.
When assessing the time to resolution between groups using a Wilcoxon chi square analysis, it was statistically significant with a p value of 0.0079.
Conclusion: Most patients with IUF have a self-limited course regardless of treatment provided.
The prevalence of similar symptoms in patients with PANDAS does question a possible relationship between IUF and Streptococcal infections.
This case series suggests a quicker resolution in IUF patients when treated for a coexisting Streptococcal infection. However, further data in a prospective series is necessary to better assess a reliable association.

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