ERs Often Misdiagnose Urinary Tract Infections

Anyone who’s ever had an urinary tract infection (UTI) understands the misery it causes and the urgency of its victims to resolve it. Even worse is when you’re diagnosed with a UTI and you actually have something else.

It’s more than a little unnerving that urinary tract and sexually transmitted infections (STIs) in women are misdiagnosed by emergency departments nearly half the time, according to research published in the Journal of Clinical Microbiology. That’s not only bad news for the individuals receiving the misdiagnoses, but for society in general, because such mistakes lead to the overuse of antibiotics.

As we’ve often noted, using antibiotics inappropriately or too often leads to resistance. That’s bad, because as bacteria evolve with overuse to develop resistance to drugs, their power to heal diminishes.

More than 1 million cases of urinary tract infections are diagnosed by emergency departments every year. The Centers for Disease Control and Prevention estimates that nearly 20 million new sexually transmitted infections occur annually, but many go unreported, and many more are undiagnosed.

“Less than half the women diagnosed with a urinary tract infection actually had one,” said Dr. Michelle Hecker, one of the study’s researchers in a news release issued by the Division of Infectious Diseases at Case Western Reserve University. “Sexually transmitted infections were missed in 37% of the women, many of whom were wrongly diagnosed with urinary tract infections.”

The researchers noted that overdiagnosing UTIs was a common cause of unnecessary antibiotic use that contributed to the underdiagnosis of STI, because more than 6 in 10 patients with a missed STI were diagnosed instead with having a UTI. A big reason why seems to be that an abnormal urinalysis, which was seen in more than 9 in 10 study subjects, was a poor predictor of the presence of a positive urine culture.

These results, Hecker said, show that how emergency departments test for both types of infection need to be re-evaluated.

Telling the difference between UTIs and STIs is tricky because the infections share certain symptoms, including dysuria (painful or difficult urination), frequency and urgency. And both can render similar findings from urinalysis.

The researchers found that women often were treated for urinary tract infections even when they didn’t have certain symptoms, and even though they did have their urine cultured (which detects the presence and kind of bacteria). About 1 in 4 study subjects diagnosed with UTIs had no possible UTI-related symptoms documented, according to the investigators write.

In addition, of 21 subjects who received antibiotic therapy within a week after urine culture (8% of the 264 total number of patients), 10 had had negative urine cultures, and 12 got antibiotics that had no effect, or limited effect, against the usual uropathogens (urinary germs).

The study examined records of women, ages 18 to 65, who were seen at the MetroHealth Medical Center emergency department in Cleveland. The investigators used urine samples provided by the patients, and tested them for the STIs gonorrhea, chlamydia and trichomonas in cases in which the tests had not been ordered as part of routine care.

If you are diagnosed with a urinary tract infection at an emergency department, and are given a prescription for antibiotics, ask if your urine has been cultured for both a UTI and STI. If not, request the test, and despite your desperation for relief as soon as possible, express in the strongest terms that you want to ensure you’re getting the right medication for the right infection. It’s about your health as well as everyone else who suffers from misdiagnosed infections due to increasing resistance to antibiotics.

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