Quigley, Jill A.
University of Northern Colorado
Type of Resources
Place of Publication
University of Northern Colorado
Sexually transmitted infections (STIs), formerly referred to as sexually transmitted diseases (STDs), remain a significant health concern in the United States. According to the Centers for Disease Control and Prevention (CDC; 2015), an estimated 20 million newly diagnosed STIs are made each year and nearly half of the cases were attributed to individuals between the ages of 15-24 with an astounding $16 billion in associated healthcare costs. Urinary tract infections (UTIs) account for nearly five million primary care office visits each year (Johnson, 1996). A urinary tract infection is the presence of bacterial infection within the urinary tract; it is generally classified by the site of microbial infection such as urine (bacteriuria), bladder (cystitis), or kidney (pyelonephritis; Foxman, 2002). Diagnosis of either an STI or UTI can be difficult as presenting and associated symptoms such as complaints of urgency, frequency, and/or dysuria are similar in nature (Tomas, Getman, Donskey, & Hecker, 2015). In addition, the results of a urinalysis (UA) might present overlapping abnormalities--most commonly pyuria and positive leukocyte esterase (Tomas et al., 2015). Less than 30% of reported chlamydial infections in women were symptomatic at time of diagnosis; most were detected through referral following required notification that a prior sexual contact or partner was found to be infected or upon routine physical examination (Marrazzo et al., 1997). Consequently, the number of patients with asymptomatic chlamydial infection results in delay in initiation of antibiotic therapy, prolonged course of infection, and increases the likelihood of disease transmission and probability of negative sequelae (Marrazzo et al., 1997). Negative sequelae and health impact of untreated chlamydial infection include ectopic pregnancy, tubal infertility, chronic pelvic pain, and pelvic inflammatory disease (PID; Marrazzo et al., 1997). To enhance quality and consistency of primary care practice, the purpose of this Doctor of Nursing Practice capstone project was to develop an evidence-based guideline for improving diagnostic screening methods for diagnosis of chlamydial and gonorrheal infections in females who present with symptomatic complaints otherwise suggestive of a urinary tract infection. Through utilization of two rounds of the Delphi method, healthcare providers in round one (six participants) and round two (four participants) provided their expert opinions regarding the necessity of a clinical practice guideline and factors that should be included within said guideline. Recommendations included age parameters (all female patients between 15-25 years of age and/or female patients older than 25 years with an identified risk factor), screening questions in assessment of risk factors (past and recent sexual history), and symptom presentation indicative of either a UTI or STI (i.e., dysuria, urinary frequency, urinary urgency, suprapubic pain, and hematuria). Implications of the Delphi method indicated the majority of participants felt routine STI testing was lacking at their respective organization, female patients were not being adequately screened for STIs when presenting with UTI complaints, and v availability of a clinical guideline would be effective in increasing STI testing rates for this patient population. Background information was collected not only through use of Delphi questionnaires but a retrospective study was conducted evaluating frequency of ICD-9 and ICD-10 codes (CDC, 2017) for UTI from January 2013 through December 2016. In addition, an in-depth chart review was performed investigating female patient visits for UTI complaints (i.e., urinary urgency, frequency, and/or dysuria) from October 2016 through December 2016. The Stetler (2001) model was used to translate the acquired research into a tangible method of practice.
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