Urinary tract infections (UTIs) and
sexually transmitted infections (
STIs) are commonly diagnosed in emergency departments (EDs). Distinguishing between these syndromes can be challenging because of overlapping symptomatology and because both are associated with abnormalities on urinalysis (UA). We conducted a 2-month observational cohort study to determine the accuracy of clinical diagnoses of UTI and
STI in adult women presenting with genitourinary (GU) symptoms or diagnosed with GU
infections at an urban academic ED. For all urine specimens, UA, culture, and
nucleic acid amplification testing for Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis were performed. Of 264 women studied, providers diagnosed 175 (66%) with UTIs, 100 (57%) of whom were treated without performing a urine culture during routine care. Combining routine care and study-performed urine cultures, only 84 (48%) of these women had a positive urine culture. Sixty (23%) of the 264 women studied had one or more positive
STI tests, 22 (37%) of whom did not receive treatment for an
STI within 7 days of the ED visit. Fourteen (64%) of these 22 women were diagnosed with a UTI instead of an
STI. Ninety-two percent of the women studied had an abnormal UA finding (greater-than-trace
leukocyte esterase level, positive
nitrite test result, or
pyuria). The positive and negative predictive values of an abnormal UA finding were 41 and 76%, respectively. In this population, empirical
therapy for UTI without urine culture testing and overdiagnosis of UTI were common and associated with unnecessary
antibiotic exposure and missed
STI diagnoses. Abnormal UA findings were common and not predictive of positive urine cultures.