Young women with symptoms of urinary tract infection: Prevalence and diagnosis of chlamydial infection and evaluation of rapid screening of bacteriuria

Abstract

Objective — To estimate the prevalence of chlamydial infection among young women with UTI symptoms. To evaluate chlamydia diagnostics with the aid of enzyme immuno assay (EIA) on first-void urine. To evaluate rapid screening of bacteriuria, including low concentrations of common pathogens.

Design — EIA for detection of Chlamydia trachomatis antigen and confirmation with immunofluorescence test (DFA) in urine, cervical and urethral chlamydia culture, nitrite and granulocyte esterase test, urine sediment, chamber count, dipslide and conventional urine culture were performed. Setting — Primary health care (PHC).

Patients — 217 women aged 15–35 years attending PHC for dysuria or urgency-frequency.

Main outcome measures — Frequency of chlamydial infections. Sensitivity, specificity, predictive values of EIA and bacteriuria screening tests, respectively.

Results — The frequency of chlamydial infection was 3.7%. In spite of a high specificity of the EIA test (0.94 without DFA) the number of false positives exceeded the number of true positives. No single bacteriuria test showed sufficient diagnostic efficiency.

Conclusions — Routine chlamydia testing in young women with UTI symptoms is recommended. EIA test on urine is of little use. Assessing diagnosis of UTI symptoms requires insight into the use of several rapid tests and a dialogue with the patient.

Key Words:

• antigen detection in urine
• bacteriuria
• Chlamydia trachomatis
• diagnostic methods
• dysuria-frequency
• primary health care
• urinary tract infection