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In order to define the etiology of urinary symptoms in rural family practice, this study examines 106 patients (88 women, 18 men) who went to their family physicians in private practice or a resident-faculty practice with genitourinary symptoms. Evaluation of each patient included history, physical examination, urinalysis, and urine or cervical cultures for bacteria, Mycoplasma, and Chlamydia. Using agar plate culturing techniques, 37 patients (35 percent) were identified as having significant urine bacteria. Chlamydia was rarely associated with urinary tract symptoms. Mycoplasma hominis, however, was isolated and felt to be etiologic in 19 (22 percent) of the 88 symptomatic women (P = 0.0026). Older women (mean age 42 years, P less than 0.001) with greater than 5 white blood cells per high-power field (WBC/hpf) on microscopic urinalysis (P less than 0.001) were likely to have cystitis and significant bacteria on urine culture. Younger women (mean age 31 years, P less than 0.001) with less than 5 WBC/hpf (P less than 0.001) had negative urine cultures and were likely to have M. hominis as a pathogen. These results demonstrate that the etiology of genitourinary symptoms seen in rural family practice may vary substantially from those seen in other patient care settings.