Sexually transmitted infections of the genital tract (STIs) and non-sexually transmitted infections of the urinary tract (UTIs) share common risk factors and presenting symptoms in women of reproductive age. Because adolescents constitute the age group at highest risk for STIs, the CDC recommends annual screening for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) in all sexually active (SA) adolescents, regardless of symptoms. Because the clinical presentations of CT, GC, Trichomonas vaginalis (TV), and UTI may be similar, many experts recommend interim testing for all four infections in SA adolescent females who have urinary symptoms. Despite these recommendations, there are important gaps between ideal and actual clinical practice. The availability of sensitive and specific, non-invasive tests for CT, GC, and TV may increase both routine and symptom-based STI screening of SA adolescents. However, important questions regarding the triage of symptomatic patients remain unanswered. The goal of the proposed study is to elucidate the association between STIs and UTIs in SA adolescent females. It focuses on the three STIs that are highly prevalent, likely to cause urinary symptoms, and detectable on tests of urine or patient-obtained vaginal samples. The study sample will consist of 474 SA adolescent females presenting to a hospital-based teen health center w/urinary symptoms (n=158) and w/o urinary symptoms (n=316). Each subject will be interviewed during the visit by a trained research assistant for chief complaint, genitourinary symptoms, sexual history, and past medical history. Prior to physical examination, each subject will provide a urine sample and a self-collected vaginal swab sample. The urine will be tested by ligase chain reaction for CT and GC and cultured for bacteria; the vaginal sample will be cultured for TV. The CT, GC and TV prevalence rates will be compared in subjects with and without urinary symptoms and in subjects with and without UTI, defined as over 1000 colonies of a single organism. Best subset logistic regression analyses will be performed to identify the variables that identify subjects with urinary symptoms who have CT, GC, and/or TV, and the variable that identify subjects with urinary symptoms who have UTIs. The findings of this study will strengthen the evidence base for symptom-based STI testing of SA adolescent females and will promote care that addresses both individual patient and public health needs. ? ?
| Huppert, Jill S; Biro, Frank; Lan, Dongmei et al. (2007) Urinary symptoms in adolescent females: STI or UTI? J Adolesc Health 40:418-24 |
| Reed, Jennifer L; Thistlethwaite, Julie M; Huppert, Jill S (2007) STI research: recruiting an unbiased sample. J Adolesc Health 41:14-8 |
