This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Anthony L. Komaroff, MD; Theodore M. Pass, PhD; Jack D. McCue, MD; Alan B. Cohen, MS; T. Michael Hendricks, MS; Gerald Friedland, MD

Arch Intern Med. 1978;138(7):1069-1073.

Abstract
Detailed history, physical examination, laboratory and follow-up data were obtained from 821 women coming to a primary care clinic over a two-year period with the symptoms of urinary tract (UTI) or vaginal infection. Using all available information, each patient retrospectively was given one of several mutually exclusive diagnoses. Vaginitis without UTI was diagnosed in 70% of patients, UTI without vaginitis in 12%, UTI and vaginitis in 2%. The conditional probability of the several possible diagnoses was calculated, given various combinations of clinical data; a diagnosis of vaginitis was twice as likely as a diagnosis of UTI in a patient with dysuria. On the basis of these calculations we identified efficient clinical strategies for when to perform a pelvic examination, a urinalysis, and a urine culture, and when to diagnose UTI presumptively on the basis of urinalysis.

(Arch Intern Med 138:1069-1073, 1978)

Author Affiliations
From the Ambulatory Care Project, Thorndike Laboratory, Department of Medicine, Division of Infectious Diseases, Harvard Medical School and Beth Israel Hospital, Boston.

Footnotes
Accepted for publication Aug 8, 1977.

Read in part before the American Federation for Clinical Research annual meeting, Washington, DC, May 2, 1977.

Reprint requests to Ambulatory Care Project, Department of Medicine, Beth Israel Hospital, 330 Brookline Ave, Boston, MA 02115 (Dr Komaroff).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Validation of a Decision Aid to Assist Physicians in Reducing Unnecessary Antibiotic Drug Use for Acute Cystitis
McIsaac et al.
Arch Intern Med 2007;167:2201-2206.
ABSTRACT | FULL TEXT  

Clinical Diagnosis of Urinary Tract Infection
Hay et al.
JAMA 2002;288:1229-1231.
FULL TEXT  

Does This Woman Have an Acute Uncomplicated Urinary Tract Infection?
Bent et al.
JAMA 2002;287:2701-2710.
ABSTRACT | FULL TEXT  

The Impact of Empirical Management of Acute Cystitis on Unnecessary Antibiotic Use
McIsaac et al.
Arch Intern Med 2002;162:600-605.
ABSTRACT | FULL TEXT  

Clinical Diagnosis and the Order of Information
Bergus et al.
Med Decis Making 1998;18:412-417.
ABSTRACT  

The Association of Urinary Tract Infection With a Recent Pelvic Examination in Women
Tiemstra and Sinacore
Arch Fam Med 1996;5:357-360.
ABSTRACT  

The Association of Urinary Tract Infection With a Recent Pelvic Examination in Women
Reed
Arch Fam Med 1996;5:361-362.
ABSTRACT  

The Limited Value of Symptoms and Signs in the Diagnosis of Vaginal Infections
Schaaf et al.
Arch Intern Med 1990;150:1929-1933.
ABSTRACT  

A Clinical Model for Diagnosis of Urinary Tract Infection in Young Women
Leibovici et al.
Arch Intern Med 1989;149:2048-2050.
ABSTRACT  

Diagnostic Reasoning
Kassirer
ANN INTERN MED 1989;110:893-900.
ABSTRACT  

Evaluation and Management of Vaginitis: An Update for Primary Care Practitioners
McCue
Arch Intern Med 1989;149:565-568.
ABSTRACT  

Decision Analysis: A Progress Report
KASSIRER et al.
ANN INTERN MED 1987;106:275-291.
ABSTRACT  

Use of Clinical Findings in Diagnosis of Urinary Tract Infection in Women-Reply
Wigton et al.
Arch Intern Med 1986;146:1235-1237.
ABSTRACT  

Diagnostic Decision: Urinalysis and Urine Culture in Women with Dysuria
KOMAROFF
ANN INTERN MED 1986;104:212-218.
ABSTRACT  

Use of Clinical Findings in the Diagnosis of Urinary Tract Infection in Women
Wigton et al.
Arch Intern Med 1985;145:2222-2227.
ABSTRACT  

Management of Acute Dysuria: A Decision-Analysis Model of Alternative Strategies
CARLSON and MULLEY
ANN INTERN MED 1985;102:244-249.
ABSTRACT  

Establishing the Cause of Genitourinary Symptoms in Women in a Family Practice: Comparison of Clinical Examination and Comprehensive Microbiology
Berg et al.
JAMA 1984;251:620-625.
ABSTRACT  

Uses of Clinical Algorithms
Margolis
JAMA 1983;249:627-632.
ABSTRACT