A Rare Case of Community-Acquired Acinetobacter Urethritis in an Immunocompetent Adult Woman.

Urethritis is most commonly caused by sexually transmitted pathogens; however, refractory presentations may indicate an atypical etiology that does not respond to empiric therapy. Acinetobacter species are Gram-negative bacilli classically associated with nosocomial infections and are an uncommon cause of community-acquired lower urinary tract infections in immunocompetent women. We present a case of severe community-acquired urethritis caused by Acinetobacter baumannii complex in a previously healthy 44-year-old woman, with concurrent isolation of Acinetobacter lwoffii of uncertain pathogenic significance. The patient presented with dysuria and pelvic pain that persisted despite a single 500-mg intramuscular dose of ceftriaxone. Nucleic acid amplification testing was negative for Chlamydia trachomatis and Neisseria gonorrhoeae. Urinalysis demonstrated microscopic hematuria without pyuria, and urine cultures showed no bacterial growth. Urethral swab culture demonstrated moderate growth of both organisms, with identification and antimicrobial susceptibility testing performed using the VITEK 2 automated system. Both isolates were susceptible to trimethoprim-sulfamethoxazole (TMP-SMX), and a 10-day course resulted in complete resolution of symptoms. This case expands the recognized clinical spectrum of Acinetobacter infections by demonstrating their potential to cause community-acquired urethritis in immunocompetent women. It highlights the diagnostic value of urethral swab culture in patients with refractory lower urinary tract symptoms and negative urine cultures and proposes a stepwise clinical framework for evaluating urethritis that fails to respond to empiric therapy.