Case reports of urethritis

Sir, Recent studies of anaerobic bacteria in both the male and female genital tracts have included techniques for the isolation of Clostridium difficile. 1-3 Hafiz et al isolated Cl difficile from 71 of vaginal specimens from patients attending a sexually transmitted disease (STD) clinic and 18% of women attending a family planning clinic, and from all of 42 men with non-specific urethritis (NSU).4 The results of more recent studies have been contradictory. Cl difficile was isolated from only two out of 79 patients with balanoposthitis, and not at all from 24 men with NSU, 19 men with both NSU and balanoposthitis, or from 28 asymptomatic controls.2 Moreover, Moss failed to isolate Cl difficile from 20 men and 34 women attending an STD clinic. A vaginal carriage rate of I% in consecutive female patients attending an STD clinic and 1807 in pregnant women was reported by O'Farrell et al using a selective broth medium.3 In this laboratory 206 vaginal swabs from 187 women, and urethral swabs from 20 men attending a special clinic were examined for Cl difficile. Swabs were broken off into cooked meat broth and incubated at 370C for five days before subculture on to modified CCFA medium,5 6 but Cl difficile was not isolated from any specimen. There exists an apparent dichotomy between the high carriage rates observed in both symptomatic and asymptomatic populations,3 4 and the negligible isolation rates encountered in this and other laboratories.1 2 This discrepancy might be explained by the use of isolation techniques of differing sensitivities, but the methods of Mossl and Masfari et a12 were essentially similar to those employed by Hafiz et al,4 and all recent investigations including the present one used enrichment culture and a highly efficient selective medium. The existence of a geographical variation in urogenital carriage of Cl difficile remains a possibility and requires further study.