Systematic literature review and meta-analysis of urinary tract infections and sexually transmitted infections in symptomatic women: prevalence, patterns and clinical implications

We performed a systematic literature review and meta-analysis of studies on urinary tract infections (UTIs) and sexually transmitted infections (STIs) in symptomatic women to evaluate prevalence, patterns and clinical implications. We searched for records in PubMed, CINAHL, Scopus, Web of Science, Embase and Cochrane that evaluated the diagnosis of UTIs and STIs in women with genitourinary tract symptoms. The studies involve women >13 years with a clinical and/or laboratory diagnosis (abnormal urinalysis or urine culture) of UTI and women who underwent diagnostic testing for typical STI pathogens. The prevalence rate of STIs in symptomatic women ranged from 9% to 53% (with a pooled prevalence of 23%). The average frequency of most detected pathogens was: Trichomonas vaginalis (18.8%), Chlamydia trachomatis (13.3%) and Neisseria gonorrhoeae (4.5%). Among women with confirmed STIs, 4.7% also had a positive urine culture. Additionally, six studies described the accuracy of clinician’s diagnosis for UTIs or STIs: UTIs ranged from 34% to 95% (mean=56.9%) and for STIs, it ranged from 26% to 75% (mean=47%). Our findings emphasise the importance of comprehensive diagnostic evaluation in symptomatic women to avoid both underdiagnosis of STIs and unnecessary antibiotic exposure for UTIs.