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Microsporidia are worldwide ubiquitous intracellular protozoan parasites, which have recently emerged as a significant cause of morbidity in immunocompromised patients, particularly in those with AIDS.' Multiorgan microsporidiosis is well described in these individuals, which underscores the severity of immunodeficiency in patients with microsporidial infection.2 3 In 15-30% of patients with advanced AIDS, Encephalitozoon bieneusi is the causative agent of major chronic diarrhoea.' Many such patients have shown dramatic responses when treated with albendazole.4 The first case of urethritis associated with microsporidiosis has recently been reported in a 36 year old AIDS patient with urethritis, sinusitis and diarrhoea.5 Encephalitozoon-like spores were isolated in a smear of expressed urethral pus. Microsporidial spores were also isolated from faeces, nasal discharge, sputum and centrifuged urinary deposit. We now report a similar case of microsporidiosis in a 35 year old homosexual patient with AIDS, who presented with sinusitis, urethritis and diarrhoea. Our patient had multiple episodes of gross urethritis with a profuse brown urethral discharge, which was only partially responsive to antibiotics. His urethritis persisted despite courses of doxycycline, erythromycin, azithromycin, rifampicin and ciprofloxacin. Clindamycin, chloramphenicol and metronidazole produced some improvement, but had to be stopped owing to the development of drug related rashes. Our patient initially presented with urethritis at the same time as his partner had diarrhoea due to intestinal microsporidiosis. We believe he was persistently infected, or reinfected, by his partner during regular unprotected sexual intercourse. Four months later our patient developed diarrhoea and microsporidium was detected in his stool. He received a four week course of albendazole 400 mg bd. It was this course of therapy that finally cleared his symptoms of urethritis. It is likely that the urethritis responded to the albendazole, which is known to treat successfully microsporidial infections.456 However, it was at this time that his partner died, so it is possible that his lack of relapse was partially due to the fact that he was no longer being sexually exposed to microsporidia. Our patient died from multiple opportunistic infections three months later, but the urethritis never recurred. We suggest that microsporidia represents an unlooked for cause of sexually transmissable urethritis. Microsporidia should be looked for actively in all non-responsive cases of urethritis in the immunocompromised. A study to this effect is currently underway. KARL BIRTHISTLE PHILIPPA MOORE Department ofMedical Microbiology, Tooting Public Health Laboratory, PHILLIP HAY Department of Genito-urinary Medicine, St George's Hospital Medical School, London, SW17 OQT, UK Correspondence to: Dr K Birthistle