At a Sexually Transmitted Infection (STI) Clinic, Is a "UTI" Actually An STI?

Background: Women without access to health care otherwise may present to an STI clinic with non-STI conditions such as possible urinary tract infection (UTI).  The CDC Sexually Transmitted Diseases Treatment Guidelines 2006 do not address whether a UTI should be treated to cover for possible Chlamydia trachomatis (CT).

Objectives: To determine, in a dedicated STI clinic, rates of CT infection in women presenting with a presumed UTI, and whether the rates are sufficient to justify empiric coverage for CT.

Methods: The Denver Metro Health Clinic (DMHC) uses a computerized encounter form.  Data collected include diagnoses and laboratory results.  For all new female visits to the clinic between 1/1/05 and 8/31/09, we compared % with CT according to whether a UTI was presumptively diagnosed on the visit (dysuria, frequency or urgency and > 10 WBC/HPF on urine microscopy), and whether contact to CT or NGU was present.  Rates of CT infection were compared by Chi-square.  Using a cutoff of 20% positivity as the criterion, the % of CT found was used to assess whether empiric treatment for CT in women with UTI was justified. 

Results: During this time 19995 new female visits to the clinic occurred, with 3906 contacts to CT or NGU and 16089 non-contacts.  UTI diagnoses were made in 80 contacts and 353 non-contacts.  CT was more common in non-contacts with UTI vs. without (13.3% vs. 9.2%, p = 0.01), but not in contacts (28.8% vs. 27.5%, p = 0.8).

Conclusions: In DMHC, women with a UTI were more likely to have CT, but only if contact to CT or NGU was not present.  The CT rate of 13.3% in non-contacts fell below the criterion of 20%.

Implications for Programs, Policy, and/or Research: Our data suggest UTI does not predict enough CT to justify empiric coverage for CT in all cases.