High Prevalence of Sexually Transmitted Diseases in Women with Urinary Infections

Abstract

Objective: To determine the prevalence and factors associated with unrecognized sexually transmitted diseases (STDs) in women who had pelvic examinations and were subsequently released from the ED with a sole diagnosis of urinary tract infection (UTI). Methods: A 3‐month retrospective chart review was performed in an urban teaching hospital ED (>70,000 visits/year). Women aged 12–45 years who had pelvic examinations and were released from the ED with a sole diagnosis of UTI were included. Patient complaints, physical findings, and laboratory results were reviewed. Laboratory evaluations included the complete blood count, urinalysis, urine pregnancy test, and cervical cultures for Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas. Results: Of the 94 women who met study criteria, 53% had proven STDs (19% N. gonorrhoeae 22% C. trachornaris 33% Trichomonas). There was no difference between the patients with positive and negative tests for STDs with regard to complaints, physical findings, and laboratory results (all p > 0.05). Conclusions: Women undergoing pelvic examinations who are subsequently released, from this urban ED with the diagnosis of UTI have a high (>50%) prevalence of occult STDs. No complaint, physical finding, or laboratory result reviewed was associated with the risk of an STD. Consideration should be given to empirical antibiotic therapy in similar urban populations.

The Prevalence of Unexpected Sexually Transmitted Diseases in Women with Lower Urinary Tract Complaints Suggestive of UTI is High

“…Our data show that 18% of sexually active women presenting to the ED with urinary tract infection complaints were found to have an STD. This adds support to the notion that STDs can be difficult to diagnose [2,5] and emphasizes the likelihood of misdiagnosis of STD because symptoms are often absent or easily misidentified as a simple urinary tract infection. , STDs continue to pose serious long term health consequences including pelvic inflammatory disease, infertility, ectopic pregnancy, salpingitis, and perinatal infections [4].…”

“…Back Pain 42% Hematuria 8% Comparisons between this prospective study (n=49), our previous retrospective study (n=60), and that of Berg et al [2] (n=94) is seen in Figure 2. Berg et al [2] examined females presenting to the ED with lower urinary complaints at a nearby but more urban locale hospital.…”

“…Using Berg et al [2] and our own previous retrospective study [3] as models, a prospective study was designed in a community teaching hospital Emergency Department (ED) in conjunction with the department of urology. Garden City Hospital Emergency Department, with >45,000 patient visits per year, is located in a suburb of Detroit, Michigan.…”

“…While most adults with UTI symptoms can be presumptively treated for simple UTI based on symptoms alone, some retrospective studies have shown that lower urinary tract complaints suggestive of UTI may be the only symptoms present in otherwise asymptomatic Sexually Transmitted Diseases (STDs) in the sexually active female [2,3]. There is danger of misdiagnosis these patients with a simple urinary tract infection, and not treating primary or co-existent STD.…”

Urinary Symptoms in Adolescent Females: STI or UTI?

“…[7] While some other studies have shown an increase in CT or GC among women with urinary symptoms or UTI, others have not. [8] [9,10] The only prospective study of adolescent girls with urinary symptoms found that 29% had an STI (TV, GC, HSV, or CT), 23% had candida vaginitis, 17% had UTI, and an additional 17% had both UTI and vaginitis. [11] However, the sample size was small, there was no asymptomatic control group, and the testing methods in 1982 were less sensitive than those that are currently available.…”