The XX Factor

Emergency Rooms May Be Overdiagnosing UTIs on a Massive Scale

Where STDs are mistaken for UTIs.

A new study in the Journal of Clinical Microbiology tracked nearly 300 female patients to find that emergency departments massively overdiagnose urinary tract infections. What’s worse, in many cases ERs fail to diagnose the sexually transmitted infections that are the real culprits behind the symptoms. This means millions of women are being put on unnecessary antibiotics for nonexistent UTIs and/or going around unaware that they have STIs.

A UTI begins when bad bacteria, usually E. coli, enters the urethra and infects part of the usually sterile urinary tract. Nearly 1 in 3 women will get a UTI at least once, and they’re the cause of nearly 7 million doctor-office visits a year. The trouble is that lower-tract UTIs and STIs often share very similar symptoms: pelvic pain, painful urination, and the urgent need to pee even when the bladder is empty. “Distinguishing between these infections can be challenging,” the researchers write.

One way that providers figure out whether you have a UTI is by doing a urinalysis, which can spot bacteria in your tract. Urinalysis has the benefit of being instant, unlike the more thorough urine culture test, which typically comes back in 24-48 hours. Unfortunately, urinalysis is also prone to contamination and frequently bears abnormal results.

“Providers really rely on this test to make the diagnosis, and it’s really not a very good test,” says Michelle Hecker, an assistant professor of infectious disease at Case Western Reserve University in Cleveland and lead author on the Journal of Clinical Microbiology study. Among the women in this study diagnosed with UTIs, less than half actually had one.

When providers see an abnormality, they often assume it means a UTI, prescribe you antibiotics, and call it a day. That’s where the problems start. First off, they might be misdiagnosing an STI, and no one wants to be walking around with an untreated STI. Second of all, unlike STIs, UTIs aren’t contagious—you could be unknowingly transmitting, say, chlamydia to your partner.

Most concerning to the researchers, though, was the threat of antibiotic resistance. Besides unpleasant side effects, taking antibiotics unnecessarily builds up antibiotic resistance: Only the strongest bacteria in your body survive, making it more difficult to treat infection in the future. In recent years, researchers have become worried about our widespread use of these powerful and commonly prescribed drugs. And at least one study has found that taking antibiotics can actually increase your chances of getting a UTI in the future.

For the study, Hecker and her team tracked 264 women who had gone to the emergency room in Ohio, 175 of whom were diagnosed with a UTI. Then they evaluated participants’ urine samples using molecular tests to determine what infection—if any—they actually had. In reality, less than half of the women diagnosed with a UTI had one. Moreover, overdiagnosing UTIs often meant underdiagnosing STIs, including gonorrhea, chlamydia, and trichomoniasis. Sixty of the 264 participants turned out to have one or more of these STIs, yet 22 of them did not receive STI treatment within a week. Of those, 14 were instead diagnosed with a UTI.

Clearly, emergency departments need to rethink the way they test for both of these types of infections. But for now, if you think you’ve got a UTI but aren’t sure, what can you do? “Honestly, if it were me, I would request a culture,” says Hecker. “And if you’re sexually active, it’s not a bad idea to get an STD test as well.”