Study: UTIs and STIs Commonly Mixed Up in ERs

Urinary tract infections (UTI) and sexually transmitted infections (STI) are frequently misdiagnosed in emergency departments, which leads to unnecessary use of antibiotics, according to results of a recent study.

In order to evaluate the accuracy of clinical diagnoses of UTI and STI in an emergency department setting, researchers conducted 2-month observational study involving 264 women, all of which presented with genitourinary symptom.
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For their study, researchers obtained urine samples from the participants and tested for both UTI and STI, then compared their results to the diagnoses given during emergency department visits.

Of the 264 women, 175 had been diagnosed with UTI and 60 tested positive for at least 1 STI.

Of the 175 diagnosed with UTI, 100 were treated without undergoing urine culture analysis and only 84 actually tested positive for UTI. Of those found to have at least 1 STI, 14 had been misdiagnosed with a UTI.

“Less than half the women diagnosed with a urinary tract infection actually had one. Sexually transmitted infections were missed in 37% of the women, many of whom were wrongly diagnosed with urinary tract infections.”

More concerning, they noted, was that 24% of women diagnosed with UTIs had no UTI-related symptoms recorded, and of 21 women who received antibiotic therapy, 10 were found to have negative urine cultures, and 12 received antibiotics which had no effect on against usual uropathogens.

“Until a more accurate rapid diagnostic test for UTI is available, or a more accurate, well validated, user-friendly clinical decision rule incorporating symptoms and urin analysis results is available, increasing urine culture and STI testing, and decreasing empiric therapy for suspected UTI or STI in this population should be evaluated,“ they concluded.

—Michael Potts

Reference:

Tomas ME, Getman D, Donskey CJ, et al. Over-diagnosis of urinary tract infection and under-diagnosis of sexually transmitted infection in adult women presenting to an emergency department.  J Clin Microbiol. June 10, 2015 [epub ahead of print] doi:10.1128/JCM.00670-15