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

Abstract

Objective: To examine the prevalence of unrecognized sexually transmitted diseases in women who present to the emergency room with urinary complaints, which generally would be treated only for urinary tract infection. Methods: An eight month, prospective study was performed in a community, teaching hospital emergency department. Sexually active women, ages 18-45, who presented with urinary complaints were solicited for participation. Physician-administered questionnaires queried the demographic, gynecologic, obstetric, sexual history, and presenting symptoms. Patient complaints, physical findings, laboratory results (urinalysis, urine culture, serum Venereal Disease Research Laboratory (VDRL), and cervical cultures for Nisseria gonorrhea, Chlamydia trachomatis, and Trichomonas) were reviewed. Results: A total of 49 patients (66% African American, 28% Caucasian, and 6% other) who met the inclusion criteria were enrolled. The mean age of our participants was 25 years. The range of sexual partners in one’s lifetime was 1 to 50, with a mean of 12.8 partners. Forty-eight percent had a history of a Sexually Transmitted Disease (STD) and 18% had active disease (C. trachomatis 8%, syphilis 2%, and Trichomonas 8%). There was no relationship between the history of a STD and positive cultures or recurrent STD. Thirty-four percent were confirmed to have a UTI. Fourteen percent were co-infected with both a STD and a UTI. Conclusion: The prevalence of occult STDs in women presenting with urinary complaints who underwent pelvic examination was 18%. The evidence emphasizes the importance of diagnosing STDs with performing a pelvic examination and culture on sexually active females with nonspecific urinary complaints, who otherwise might be misdiagnosed as having a simple urinary tract infection.