[vo2maxer]

Why do a urinalysis at all when most treatment for acute uncomplicated UTI in females, complaining of cystitis and/or urethritis, is empiric as long as there are no signs of pyelonephritis? Urinalysis in the treatment of urinary tract infections is probably one of the most useless tests done in an urgent setting. Urine culture remains the gold standard particularly in areas of high anti microbial resistance.

[stephenlchen]

Great question! While empiric treatment for most patients presenting with acute uncomplicated UTIs is appropriate, recent studies (happy to share these) have shown that 30-50% of the time these patients are being overtreated. Our test result + patient’s symptoms increases the diagnostic accuracy significantly and can help reduce the misuse of antibiotics. With the growing threat of antibiotic resistance, we believe having a cheap and accessible screening test like ours can make a big difference in the care of this common problem.

[vo2maxer]

Over treatment with antibiotics is rampant not only with genitourinary syndromes but even more with respiratory diseases. I am not sure how a female patient, afebrile, without any other morbidity, presenting with classic symptoms of dysuria, urgency, frequency, and hematuria, but having a normal urinalysis, would dissuade me from prescribing antibiotics empirically. As much as most physicians would do a urinalysis routinely, just because it’s done like many other unnecessary tests, it adds little to the management. And let’s not even go into the challenges of obtaining a clean catch. What I would do if not sure of the organism or the patient had been previously treated, is to order a urinalysis with a reflex urine culture.

Nonetheless, after my argument against the use of urinalysis in managing an uncomplicated UTI, I still think you may have a winner given that testing is still widely done. If you have robust medical provider support who understands the limitations, then a significant number of patients would benefit without incurring the large cost or time spent seeking help.

[stephenlchen]

Thank you for your comments. We agree that in the situation you described it is likely that woman would get treated with empiric antibiotics regardless of what her test results show since false negatives are still possible. This is why the telehealth visit always combines test results with additional information from the patient. From our experience, not every person presents with all of the classic UTI symptoms. Having the positive leukocyte/nitrite results provide the telehealth clinicians the confidence they need to treat these patients. For patients with negative results, it provides another data point to recommend in-person evaluation. We also recognize the challenge of obtaining a midstream sample, which is why we have spent a lot of time and effort (including user interviews and focus groups) to create simple to follow instructions in our app.

We would love to chat further about any additional concerns you may have. Feel free to contact us at [e-mail]. Thanks for taking the time to review our product and leaving your comments!