We reviewed the case of three of our own patients who had osteomyelitis of the symphysis pubis, as well as those of twenty-five patients described in the literature. The early symptoms of osteomyelitis of the symphysis mimic those of osteitis pubis. Osteomyelitis almost invariably is preceded by urological or gynecological surgery (often when a technical complication has occurred), and does not respond to shortterm antibiotic treatment. Characteristic radiographic findings develop. Osteomyelitis of the symphysis pubis should be treated by debridement and curettage, together with long-term treatment with an appropriately high dose of antibiotics.
“Athletic pubalgia” is a general term that encompasses a wide range of injuries at the symphysis pubis that share a similar injury mechanism and clinical presentation of exertional pubic and groin pain 5 . Groin pain most commonly develops insidiously, but may present acutely with a clinical history of a sudden tearing sensation. Symptoms are most often unilateral but may be bilateral. The patient typically experiences pain during exercise, complaining of discomfort in the inguinal region over the distal rectus abdominis, in the perineum, or radiating to the testicles. On physical examination, the patient may experience pain with resisted hip adduction or resisted sit-ups 4 . Local tenderness may be elicited at the attachments of the adductor longus or rectus abdominis or over the external inguinal ring, and Valsalva maneuver may cause pain.