General: Certain genitourinary and gastrointestinal infections have been shown to cause Reiter's syndrome. This occurs when the disease-causing bacteria travel to other areas of the body, where they cause inflammation.
It remains unknown why only some patients get Reiter's syndrome after they are exposed to these bacteria. However, researchers have discovered a genetic (biological) factor that increases an individual's chance of developing the disorder. About 80% of patients with Reiter's syndrome have a mutated gene that leads to the development of an abnormal human leukocyte antigen (HLA) called HLA-B27.
It remains unknown exactly how the HLA-B27 molecule triggers the inflammatory response in the body. It has been suggested that it occurs when an infectious organism that looks similar to HLA-B27 enters the body. In such cases, researchers believe that the immune system mistakes the patient's own cells that contain the HLA-B27 molecule for the disease-causing bacteria. In essence, the immune system attacks itself (a condition called autoimmunity) and symptoms of Reiter's syndrome appear. It has also been suggested that the HLA-B27 molecules attach to the infectious bacteria. This may cause the immune system to attack itself and trigger the disease. A third theory is that the HLA-B27 molecule is linked to an unidentified gene that triggers the immune response.
Genitourinary tract infection: A sexually transmitted genitourinary tract infection, called chlamydia, is the most common cause of Reiter's syndrome. This infection is caused by a bacterium called Chlamydia trachomatis. Most cases of chlamydia are transmitted from person to person through oral, anal, or vaginal sex. Less commonly, Reiter's syndrome may be caused by gonorrhea (another common STD).
Gastrointestinal tract infection: Many types of bacteria known to cause infections in the gastrointestinal tract have been linked to Reiter's syndrome. The most common bacteria to cause Reiter's syndrome include salmonella, shigella, yersinia, and campylobacter. People become infected after consuming food or beverages that are contaminated with these bacteria. This type of infection may occur if produce is not properly washed or meat is not stored or cooked at the appropriate temperature.
General: There are no specific tests available to diagnose Reiter's syndrome. Instead, the healthcare provider will take a detailed medical history and perform a physical examination.
Culture swab: A culture swab may be used to determine if chlamydia is causing symptoms of Reiter's syndrome. For females, the healthcare provider may swab the discharge from the cervix. For males, the healthcare provider inserts a thin swab into the tip of the penis to retrieve a sample of fluid from the urethra. In some cases, the healthcare provider may swab the anus. The sample is then rubbed on a petri dish. If the patient has chlamydia, Chlamydia trachomatis will grow on the petri dish.
Blood tests: Blood tests may be performed to diagnose a bacterial infection that may have caused Reiter's syndrome.
A blood test may also be performed to determine if the patient has the HLA-B27 tissue type. Having this tissue type does not necessarily mean that the patient has Reiter's syndrome. This is because the HLA-B27 molecule has also been linked to other conditions, including rheumatic diseases and acute anterior uveitis. However, testing positive for the molecule means that the patient has an increased risk of developing the condition.
Eye exam: An eye exam may also be performed to determine if the patient has conjunctivitis, uveitis, or iritis. An eye doctor may use a microscope, called a slit lamp, to determine if parts of the eye are inflamed or irritated. However, if the patient does not have eye problems it does not rule out the possibility of Reiter's syndrome. This is because only 50% of patients with Reiter's syndrome have conjunctivitis, and even fewer develop uveitis or iritis.
signs and symptoms
General: The most common symptoms of Reiter's syndrome include arthritis, eye inflammation and irritation, and urinary tract problems. Individuals may have received treatments for the initial infection several weeks before Reiter's syndrome develops. In general, symptoms of Reiter's syndrome usually start to appear one to three weeks after the patient has developed a genitourinary or gastrointestinal infection. Symptoms of Reiter's syndrome typically come and go over the course of several weeks to months. The severity of symptoms varies among patients. Women typically experience milder symptoms than men.
Arthritis: Patients typically develop arthritis, which causes pain and inflammation of the joints. Pain typically worsens when the patient moves the joints. Swelling typically develops where a tendon attaches to a bone, a condition called enthesopathy. The knees, ankles, and feet are most commonly affected. The wrists, fingers, and other joints are less commonly affected. Symptoms typically develop on both sides of the body. In addition, some patients may develop bony growths in the heels of the feet (called heel spurs) that cause long-lasting foot pain.
In some cases, arthritis may develop in the back and cause inflammation of the bones in the spine (a condition called spondylitis) or inflammation of the joints in the lower back that connect the spine to the pelvis (called sacroiliitis). Patients who have HLA-B27 are the most likely to experience arthritis of the back.
Arthritis may last anywhere from two to six months. For most patients, the symptoms are usually mild and do not interfere with daily activities. Most patients do not experience permanent joint damage.
Eye irritation and inflammation: About 50% of patients with urogenital Reiter's syndrome and 75% of patients with gastrointestinal Reiter's syndrome develop a condition called conjunctivitis, which causes inflammation of the transparent membrane that covers the eyeball. Conjunctivitis may cause the eyes to become red, irritated, and painful.
Although less common, some patients may develop more serious eye conditions called iritis and uveitis. Iritis occurs when the colored portion of the eye becomes inflamed. Uveitis describes inflammation of the inner layers of the eye. Iritis and uveitis may cause eye pain, redness, and blurred vision. If left untreated, patients may experience permanent vision loss or blindness. Iritis and uveitis are most likely to occur in individuals with the HLA-B27 tissue type.
Urinary tract: Reiter's syndrome typically affects the urinary tract. Symptoms may develop in the prostate, urethra, and penis in men and the fallopian tubes, uterus, cervix, vagina, and urethra in women. Common symptoms in males include a burning sensation during urination, increased urge to urinate, and penile discharge. Some men may develop an inflamed prostate, a condition called prostatitis. Symptoms of prostatitis may include chills, fever, burning sensation during urination, difficulty urinating, and increased urge to urinate.
Common symptoms in women include inflammation of the cervix and inflammation of the urethra, which may lead to a burning sensation during urination. Some women may experience inflamed fallopian tubes (called salpingitis) or inflammation of the vulva and vagina (called vulvovaginitis). Salpingitis and vulvovaginitis may not cause any symptoms.
Other: Some male patients may also develop painless sores, called balanitis circinata, on the tip of their penises. Less commonly, patients may develop small hard bumps, called nodules, on the bottoms of their feet. In some cases, nodules may develop on the palms of the hands or other areas of the body. A few patients may also develop mouth sores that come and go. These mouth sores may or may not be painful.
Heart problems: An estimated 10% of patients with Reiter's syndrome develop heart problems, which may include leakage of blood from the aorta into the heart chamber (called aortic regurgitation) and inflammation of the membrane that surrounds the heart (called pericarditis). These conditions can be serious. For instance, severe aortic regurgitation may lead to a life-threatening infection of the heart lining or congestive heart failure. Heart problems are most common among patients who have chronic Reiter's syndrome. Individuals who already have heart disease may have an increased risk of developing heart problems associated with Reiter's syndrome.
Permanent vision loss: If patients with iritis and/or uveitis do not receive immediate medical treatment, they may suffer from permanent vision loss. Therefore, it is important for patients to visit their doctors as soon as symptoms develop.
Infertility: Patients may experience temporary infertility if the genitourinary organs, such as the prostate or fallopian tubes, become inflamed. However, fertility problems generally resolve once inflammation subsides.
Transmitting infections: If the infection that causes Reiter's syndrome is not treated, it may be spread to others, including sexual partners and babies during vaginal childbirth. However, Reiter's syndrome itself is not contagious or sexually transmitted.