Reiter's disease in the female.

An increasing amount of interest is being shown in Reiter's disease and it is now recognized that the condition is commoner than was at one time believed. In many cases the complete triple syndrome does not occur, or is not recognized, as the ocular and genital components may be symptomless and escape detection unless specially looked for. The disease may be associated either with bacillary dysentery, non-specific diarrhoea, or a venereally acquired urethritis. These forms pursue a virtually identical clinical course and have been called the "dysenteric" and "venereal" syndrome by Harkness (1950a). A curious feature is that the dysenteric syndrome is apparently very rare in Great Britain (Corner, 1950) though it is commonly reported on the continent of Europe (Marche, 1954; Bourel, 1954; Paronen, 1948). Conversely, the "venereal" syndrome appears to be rare in Europe. All authorities agree that the "venereal" syndrome rarely affects the female, indeed some have gone so far as to deny its occurrence in women (Storm-Mathisen, 1946; Lofgren, 1946; Twiss and Douglas, 1946; Vallee, 1946). The existence of the dysenteric syndrome in women was noted, however, in the mid-19th century by Huette (1869). Zewi (1947), in a paper dealing with the ophthalmological complications of Reiter's disease, described six cases in females. Young and McEwen (1947) recorded fourteen cases with the dysenteric syndrome, one in a woman. Paronen (1948) compiled the largest series of cases of Reiter's disease associated with an epidemic of bacillary dysentery, during the second world war in Finland, and of his 344 patients, 34 (9 9 per cent.) were women. The sex distribution of cases of dysentery in this epidemic is not stated, nor whether there was any difference in the clinical course of Reiter's disease in males and females. Harkness (1950b) could recall seeing only three female patients with polyarthritis, nongonococcal cervical discharge, and keratoderma. These were presumably examples of the venereally acquired syndrome. Rinkoff (1952) described in detail a woman who developed an attack of Reiter's 37 disease with uveitis; there was no evidence of intestinal infection. Stanworth and Sharp (1956) reported on nine female patients whom they considered had Reiter's disease; three of these had radiographic changes of sacro-iliitis and suffered from attacks of recurrent uveitis. Dysentery was not considered to be an aetiological factor in these cases. More recently Refvem (1957) has reported three further cases.