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.
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.”
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