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. 2021 Aug 11;11(8):e050407.
doi: 10.1136/bmjopen-2021-050407.

Sexually transmitted infections and prior antibiotic use as important causes for negative urine cultures among adults presenting with urinary tract infection symptoms to primary care clinics in Zimbabwe: a cross-sectional study

Ioana D Olaru  1   2 , Mutsawashe Chisenga  2 , Shunmay Yeung  3   4 , David Mabey  3 , Michael Marks  3 , Prosper Chonzi  5 , Kudzai Pe Masunda  5 , Anna Machiha  6 , Rashida A Ferrand  3   2 , Katharina Kranzer  3   2   7
Affiliations

Sexually transmitted infections and prior antibiotic use as important causes for negative urine cultures among adults presenting with urinary tract infection symptoms to primary care clinics in Zimbabwe: a cross-sectional study

Ioana D Olaru et al. BMJ Open. .

Abstract

Objective: Urinary tract infections (UTIs) are common in primary care. The yield of urine cultures in patients with UTI symptoms can be considerably different between high-income and low-income settings. This study aimed to explore possible causes of negative urine cultures in patients presenting with symptoms of UTI to primary health clinics in Harare.

Design: Cross-sectional study.

Setting: Nine primary health clinics in Harare, Zimbabwe.

Participants: Adults presenting with symptoms of UTIs between March and July 2020.

Primary outcome measures: Urine samples underwent dipstick testing, microscopy, culture, and testing for sexually transmitted infections (STIs) using GeneXpert and for the presence of antibiotic residues using an antibiotic bioassay. The primary outcomes were the number and proportion of participants with evidence of STIs, prior antibiotic exposure, leucocyturia and UTIs.

Results: The study included 425 participants with a median age of 37.3 years, of whom 275 (64.7%) were women. Leucocyturia was detected in 130 (30.6%, 95% CI 26.2% to 35.2%) participants, and 96 (22.6%, 95% CI 18.7% to 26.9%) had a positive urine culture for a uropathogen. Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis were detected in 43/425 (10.1%, 95% CI 7.4% to 13.4%), 37/425 (8.7%, 95% CI 6.2% to 11.8%) and 14/175 (8.0%, 95% CI 4.4% to 13.1%) participants, respectively. Overall, 89 (20.9%, 95% CI 17.2% to 25.1%) participants reported either having taken prior antibiotics or having had a positive urine bioassay. In 170 (40.0%, 95% CI 35.3% to 44.8%) participants, all of the tests that were performed were negative.

Conclusions: This study found a high prevalence of STIs and evidence of prior antimicrobial use as possible explanations for the low proportion of positive urine cultures.

Keywords: epidemiology; primary care; sexual medicine; urinary tract infections.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Distribution of positive tests among study participants (170/425 samples; 40% were negative for all tests). STI, sexually transmitted infection.
Figure 2
Figure 2
Presenting symptoms in study participants according to urine culture and STI test result. Severe symptoms were defined as symptoms affecting daily activities. STI, sexually transmitted infection.
See this image and copyright information in PMC

References

    1. Foxman B, Barlow R, D'Arcy H, et al. . Urinary tract infection: self-reported incidence and associated costs. Ann Epidemiol 2000;10:509–15. 10.1016/s1047-2797(00)00072-7 - DOI - PubMed
    1. Heytens S, Boelens J, Claeys G, et al. . Uropathogen distribution and antimicrobial susceptibility in uncomplicated cystitis in Belgium, a high antibiotics prescribing country: 20-year surveillance. Eur J Clin Microbiol Infect Dis 2017;36:105–13. 10.1007/s10096-016-2776-8 - DOI - PubMed
    1. Michels TC, Sands JE. Dysuria: evaluation and differential diagnosis in adults. Am Fam Physician 2015;92:778–86. - PubMed
    1. World Health Organization . IMAI district clinician manual: hospital care for adolescents and adults: guidelines for the management of illnesses with limited-resources. Geneva: WHO, 2011. https://apps.who.int/iris/bitstream/handle/10665/77751/9789241548281_Vol...
    1. Iregbu KC, Nwajiobi-Princewill PI. Urinary tract infections in a tertiary hospital in Abuja, Nigeria. African Journal of Clinical and Experimental Microbiology 2013;14:169–73. 10.4314/ajcem.v14i3.9 - DOI

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