Sexually transmitted infections (STIs) are primarily spread through sexual contact, while urinary tract infections (UTIs) are usually contracted from bacteria passed on through the urinary tract. Both types of infections can have similar symptoms, but treatments and complications for a UTI vs. STI are very different.
There were more than 2.4 million STIs reported in the United States in 2023; however, there are promising signs the epidemic may be slowing:
• Gonorrhea dropped for a second year—declining 7% from 2022 and falling below pre-COVID-19 pandemic levels.
• Overall, syphilis increased by only 1% after years of double-digit increases.
• Primary and secondary syphilis declined for the first time in more than two decades, down 10% since 2022. These cases also dropped 13% among gay and bisexual men for the first time since CDC began reporting national trends among this group in the mid-2000s.
Discussion: Sexually Transmitted disease or UTI?
John is a 20 year old college student who presents with pain and a burning sensation during urination, a sudden urge to empty his bladder, and pain in his lower abdomen . He is concerned that he might have a sexually transmitted disease as he has had unprotected intercourse with three different partners in the past month.
- What other questions do you want to ask John when getting a sexual history?
- What tests would you do and why?
- What patient education would you provide?
- What are the (CDC), Center for Disease Control recommendations for the treatment of sexually transmitted diseases and UTIs?
Full Answer Section
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- Any sores, bumps, blisters, or rashes on his genitals, anus, or mouth.
- Pain during intercourse.
- Pain in the testicles.
- Swollen lymph nodes in the groin area.
- Partner history (if known and appropriate to ask):
- Has any of his partners reported similar symptoms or been diagnosed with an STI?
- Does he know the STI status of his partners?
- Previous STI history:
- Has he ever been diagnosed with an STI in the past? If so, which one(s) and what treatment did he receive?
- Sexual practices:
- Number of lifetime sexual partners.
- Specific sexual practices (e.g., receptive anal sex).
- Contraceptive use history:
- Typical methods of contraception used, if any.
- Other relevant medical history:
- Any known allergies.
- Any other current medical conditions.
2. What tests would you do and why?
Based on John's symptoms and sexual history, I would consider the following tests to differentiate between a UTI and STIs:
- Urinalysis: This is a fundamental first-line test for suspected UTIs. It can detect:
- Leukocyte esterase and nitrites: Indicators of white blood cells and bacteria, suggesting infection.
- Red blood cells: May indicate inflammation or irritation in the urinary tract.
- Bacteria: Direct visualization of bacteria can support a UTI diagnosis.
- Urine Culture and Sensitivity: If the urinalysis suggests a UTI, a urine culture will identify the specific bacteria causing the infection and determine which antibiotics will be most effective for treatment.
- Nucleic Acid Amplification Tests (NAATs): These are highly sensitive tests for common STIs and can be performed on a urine sample or swabs (urethral, rectal, oral, depending on reported sexual contact). I would consider NAATs for:
- Chlamydia trachomatis: A common STI that can cause symptoms similar to a UTI.
- Neisseria gonorrhoeae: Another common STI with overlapping symptoms.
- Trichomonas vaginalis: A parasitic STI that can cause urinary symptoms.
- Blood Tests (depending on risk and other symptoms):
- Syphilis serology (RPR or VDRL with confirmatory test like FTA-ABS): Given the increase in syphilis rates and John's unprotected sex history, this should be considered, although primary syphilis might not present with urinary symptoms initially.
- HIV testing: Offered as part of routine sexual health screening, especially with a history of unprotected sex.
- Herpes simplex virus (HSV) PCR or culture (if lesions are present): If John reports or exhibits any genital sores or blisters.
Rationale for Testing:
- Urinalysis and Culture: To quickly assess for a bacterial urinary tract infection and guide antibiotic treatment if present.
- NAATs: To rule out or confirm common STIs that can mimic UTI symptoms and require different treatments. Urine NAATs are often the least invasive method for initial STI screening in men.
- Blood Tests: To screen for syphilis and HIV, which may not always present with obvious initial symptoms but are important to diagnose and treat early. HSV testing is indicated if specific lesions are present.
3. What patient education would you provide?
Regardless of the initial diagnosis, it's crucial to provide John with comprehensive patient education:
- Explanation of Potential Diagnoses: Explain that his symptoms could be due to a UTI, an STI, or potentially both. Emphasize the importance of testing to determine the correct diagnosis.
- Importance of Completing Testing: Stress the need to complete all recommended tests to ensure accurate diagnosis and appropriate treatment.
- Safe Sexual Practices:
- Discuss the importance of consistent and correct condom use for all types of sexual contact to prevent STIs.
- Explain the risks associated with unprotected sex and multiple partners.
- Provide information about different methods of STI prevention.
- Transmission of STIs and UTIs: Clearly explain how STIs are spread (primarily through sexual contact) and how UTIs are typically contracted (bacteria entering the urinary tract). Address any misconceptions John might have.
- Importance of Partner Notification (if STI is diagnosed): If an STI is diagnosed, explain the importance of informing his sexual partners so they can get tested and treated to prevent further spread and complications. Provide resources and support for partner notification.
- Abstinence from Sexual Activity: Advise him to abstain from all sexual activity until he receives his test results and, if diagnosed with an infection, has completed the full course of treatment and is cleared by a healthcare provider.
- Follow-up Instructions: Provide clear instructions on when and how to follow up for his test results and any necessary treatment.
- Symptom Management: Offer advice on managing his current symptoms (e.g., drinking plenty of fluids for potential UTI, avoiding irritants).
- Consequences of Untreated Infections: Explain the potential short-term and long-term complications of untreated UTIs (e.g., kidney infection) and STIs (e.g., pelvic inflammatory disease, infertility, chronic pain).
- Resources for Sexual Health: Provide information on local sexual health clinics, websites, and other resources for testing, treatment, and education.
4. What are the (CDC), Center for Disease Control recommendations for the treatment of sexually transmitted diseases and UTIs?
The CDC provides detailed treatment guidelines for STIs and UTIs, which are regularly updated based on the latest evidence. Here's a general overview of their recommendations, but specific treatment should always follow the most current CDC guidelines:
Sample Answer
1. What other questions do you want to ask John when getting a sexual history?
A comprehensive sexual history is crucial to assess John's risk for STIs. Beyond the information provided, I would ask the following questions:
- Details about each sexual encounter:
- Dates of each encounter.
- Types of sexual contact (vaginal, anal, oral).
- Whether condoms were used consistently and correctly during each encounter.
- Relationship status with each partner (casual, ongoing).
- Symptoms related to potential STIs:
- Any penile discharge (color, consistency, odor).