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Literature reviews > Articles for review > Shapiro et al. The prevalence of urinary tract... |
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The proportion of women with an STD was not significantly different between those with and those without a urinary tract infection. The prevalence of urinary tract infections and sexually transmitted diseaes in women with symptoms of a simple urinary tract infection stratified by low colony count criteria. Question What proportion of women with symptoms suggestive of a urinary tract infection (UTI), who are urine culture positive, is infected with N. gonorrhoeae, C. trachomatis, or T. vaginalis compared to the urine culture negative group, and which variables predict an STD among women with symptoms suggestive of a UTI? Design This article describes a prospective, observational cohort study to determine the prevalence of infection with N. gonorrhoeae, C. trachomatis, or T. vaginalis among women with and without a positive urine culture who presented to an urban hospital emergency department with symptoms suggestive of a simple UTI. Participants A convenience sample of 92 women (mean age = 26 years, range = 18 to 51 years) with urinary frequency, urgency, dysuria, or suprapubic pain or pressure and no new vaginal discharge or change in discharge, who were seen in an urban emergency department, was tested. Women were excluded if they had used antibiotics or had a UTI within the previous two weeks, had been diagnosed with chlamydia, gonorrhea, yeast vaginitis, or trichomoniasis within the past month, had a temperature >100.4oF, had a hysterectomy, or were pregnant. The mean number of sex partners in the previous year was 1.6. Description of Tests and Diagnostic Standard Urine was collected via straight catheterization of the bladder and split into aliquots for urinalysis (n = 85) or urine dip (nitrate and leukocyte esterase) (n = 7) and urine culture (n = 75).More than 5 white blood cells per high power microscopic field, 1+ or greater leukocyte esterase, and positive nitrates were considered abnormal findings. Urine cultures were considered positive if 100 or more colony forming units per mL were detected. Endocervical specimens for gonorrhea and chlamydia testing using PCR (COBAS AMPLICOR Analyzer, Roche, Indianapolis, IN) were obtained during a pelvic examination (n = 92).Wet mount preparations of vaginal secretions were examined for detection of T. vaginalis, Gardnerella, and budding yeast. The results of 75 women were used for analysis of the prevalence of UTI and STD. Main Outcome Measures The percentage of women who were urine culture positive, and the proportion of women with an STD among the urine culture positive and culture negative women were determined. Variables that might predict which patients had an STD were determined using logistic regression analysis. Main Results Forty-three (57.3%) and 13 (17.3%) of 75 women were positive for UTI and STD, respectively. Nine, 1, and 7 patients were positive for chlamydia, gonorrhea, and trichomoniasis, respectively. One C. trachomatis positive patient was also positive for N. gonorrhoeae and 2 were also positive for T. vaginalis. Eight (18.6%) of the 43 urine culture positive and 5 (15.6%) of the 32 urine culture negative women were positive for an STD (p = 0.56). The number of sexual partners over the past year was the only variable significant in predicting patients with an STD (p = 0.013).The sensitivity and specificity of diagnosing an STD by history, examination, and urine dip alone were 50% and 85.6%, respectively. Authors' Conclusions Among the women with simple urinary symptoms, 42.7% were urine culture negative while 17.3% were STD positive, suggesting that the diagnoses of UTI and STD may be more difficult than generally believed. Fifty percent of women with an STD were not diagnosed while in the emergency department. Source of funding: Healthcare Foundation of New Jersey For correspondence: Tara Shapiro, Department of Emergency Medicine, Bronx Lebanon Hospital, 1276 Fulton Avenue, Bronx, NY 10456.E-mail address: tarashap@optonline.net |
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