Urinary tract infection: value of early diagnosis

Abstract

There is no doubt that UTI is an important public health problem. In general practice, 12 per 1000 consultations are the result of symptoms which suggest UTI. Mortality statistics reveal an increase in deaths from infection of the kidney which may not be entirely due to a change in diagnostic habit and acuity. The diagnosis of UTI in a latent phase of the disease is now possible, by methods acceptable to the population, at reasonable cost. Facilities for screening would be relatively simple to provide in antenatal clinics, but if bacteriuria screening were to be extended to schoolgirls and nonpregnant women, the provision of facilities and staff would involve considerable expenditure. The value of screening for significant bacteriuria in pregnancy is well established, since treatment of the bacteriuria largely prevents maternal pyelonephritis. This conclusion does not apply to the vast majority of bacteriuric women, i.e., those who are not pregnant. Treatment of bacteriuria by means suitable for largescale use confers no lasting benefit on them. Screening of nonpregnant women could be justified only if longterm prospective studies show that bacteriuria produces progressive kidney damage leading to kidney failure which can be prevented by treatment. So far, the results of studies do not show such a trend. Finally, it is important that the controlled treatment trials of covert bacteriuria in childhood which are now in progress are completed and that medical opinion on the value of screening for UTI in schoolgirls is not allowed to crystallize before the results of these studies are available.