Adolescent female with urinary symptoms: a diagnostic challenge for the pediatrician

The objective of this study was to determine the accuracy with which physicians diagnose sexually transmitted infections (STIs) and urinary tract infections (UTIs) in adolescent females with urinary symptoms. Secondary aims were to determine the prevalence of STIs and UTIs in this subset of patients and to identify variables associated with a physician diagnosis of STI or UTI.

We performed a prospective cross-sectional study of females aged 13 to 21 years who presented to an urban pediatric emergency department with urinary symptoms. Pediatric emergency medicine physicians' diagnoses of STI or UTI were compared with the criterion standard of diagnosis.

Of the 233 patients enrolled, 211 had complete data sets and were included for analysis. Nineteen patients (9%) had STIs. Physicians predicted STIs in 35 patients (17%), of which 9 (25%) had true infections. Sexually transmitted infections in 10 patients (53%) were underdiagnosed, in 26 patients (74%) were overdiagnosed, and in 9 patients (26%) were correctly diagnosed. One hundred twenty patients (57%) had UTIs. Physicians predicted UTIs in 156 patients (74%), of which 107 (69%) had culture-confirmed UTIs. Urinary tract infections in 13 patients (11%) were underdiagnosed, in 49 patients (31%) were overdiagnosed, and in 107 patients (66%) were correctly diagnosed. Thirteen patients (6%) had a coinfection with both an STI and a UTI.

Pediatric emergency medicine physicians both underdiagnose and overdiagnose STIs and UTIs in patients with urinary symptoms. This diagnostic challenge necessitates that all adolescent patients presenting with urinary symptoms should be tested for STIs and UTIs and have adequate follow-up means established to ensure timely treatment.