{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T07:33:46Z","timestamp":1785224026098,"version":"3.55.0"},"reference-count":25,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2021,8,11]],"date-time":"2021-08-11T00:00:00Z","timestamp":1628640000000},"content-version":"unspecified","delay-in-days":10,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010269","name":"Wellcome","doi-asserted-by":"publisher","award":["203905\/Z\/16\/Z awarded to the London School of Hygi"],"award-info":[{"award-number":["203905\/Z\/16\/Z awarded to the London School of Hygi"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"name":"UK aid from the UK government","award":["No grant number"],"award-info":[{"award-number":["No grant number"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,8,4]]},"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Urinary tract infections (UTIs) are common in primary care. The yield of urine cultures in patients with UTI symptoms can be considerably different between high-income and low-income settings. This study aimed to explore possible causes of negative urine cultures in patients presenting with symptoms of UTI to primary health clinics in Harare.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Cross-sectional study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Nine primary health clinics in Harare, Zimbabwe.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>Adults presenting with symptoms of UTIs between March and July 2020.<\/jats:p><\/jats:sec><jats:sec><jats:title>Primary outcome measures<\/jats:title><jats:p>Urine samples underwent dipstick testing, microscopy, culture, and testing for sexually transmitted infections (STIs) using GeneXpert and for the presence of antibiotic residues using an antibiotic bioassay. The primary outcomes were the number and proportion of participants with evidence of STIs, prior antibiotic exposure, leucocyturia and UTIs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The study included 425 participants with a median age of 37.3 years, of whom 275 (64.7%) were women. Leucocyturia was detected in 130 (30.6%, 95%\u2009CI 26.2% to 35.2%) participants, and 96 (22.6%, 95%\u2009CI 18.7% to 26.9%) had a positive urine culture for a uropathogen.<jats:italic>Chlamydia trachomatis<\/jats:italic>,<jats:italic>Neisseria gonorrhoeae<\/jats:italic>and<jats:italic>Trichomonas vaginalis<\/jats:italic>were detected in 43\/425 (10.1%, 95%\u2009CI 7.4% to 13.4%), 37\/425 (8.7%, 95%\u2009CI 6.2% to 11.8%) and 14\/175 (8.0%, 95%\u2009CI 4.4% to 13.1%) participants, respectively. Overall, 89 (20.9%, 95%\u2009CI 17.2% to 25.1%) participants reported either having taken prior antibiotics or having had a positive urine bioassay. In 170 (40.0%, 95%\u2009CI 35.3% to 44.8%) participants, all of the tests that were performed were negative.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study found a high prevalence of STIs and evidence of prior antimicrobial use as possible explanations for the low proportion of positive urine cultures.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2021-050407","type":"journal-article","created":{"date-parts":[[2021,8,11]],"date-time":"2021-08-11T17:11:42Z","timestamp":1628701902000},"page":"e050407","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Sexually transmitted infections and prior antibiotic use as important causes for negative urine cultures among adults presenting with urinary tract infection symptoms to primary care clinics in Zimbabwe: a cross-sectional study"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3392-9257","authenticated-orcid":false,"given":"Ioana D","family":"Olaru","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mutsawashe","family":"Chisenga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0997-0850","authenticated-orcid":false,"given":"Shunmay","family":"Yeung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Mabey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7585-4743","authenticated-orcid":false,"given":"Michael","family":"Marks","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prosper","family":"Chonzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kudzai PE","family":"Masunda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Machiha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rashida A","family":"Ferrand","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharina","family":"Kranzer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,8,11]]},"reference":[{"key":"2024112509025592000_11.8.e050407.1","doi-asserted-by":"publisher","DOI":"10.1016\/S1047-2797(00)00072-7"},{"key":"2024112509025592000_11.8.e050407.2","doi-asserted-by":"publisher","DOI":"10.1007\/s10096-016-2776-8"},{"key":"2024112509025592000_11.8.e050407.3","first-page":"778","article-title":"Dysuria: evaluation and differential diagnosis in adults","volume":"92","author":"Michels","year":"2015","journal-title":"Am Fam Physician"},{"key":"2024112509025592000_11.8.e050407.4","unstructured":"World Health Organization . IMAI district clinician manual: hospital care for adolescents and adults: guidelines for the management of illnesses with limited-resources. Geneva: WHO, 2011. https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/77751\/9789241548281_Vol1_eng.pdf"},{"key":"2024112509025592000_11.8.e050407.5","first-page":"169","article-title":"Urinary tract infections in a tertiary hospital in Abuja, Nigeria","volume":"14","author":"Iregbu","year":"2013","journal-title":"African Journal of Clinical and Experimental Microbiology"},{"key":"2024112509025592000_11.8.e050407.6","doi-asserted-by":"crossref","first-page":"140","DOI":"10.12688\/wellcomeopenres.15977.1","article-title":"Antimicrobial resistance in gram-negative bacteria from urinary specimens: a study of prevalence, risk factors and molecular mechanisms of resistance (ARGUS) in Zimbabwe - a study protocol","volume":"5","author":"Olaru","year":"2020","journal-title":"Wellcome Open Res"},{"key":"2024112509025592000_11.8.e050407.7","doi-asserted-by":"crossref","first-page":"S159","DOI":"10.1093\/cid\/cir1061","article-title":"Disk diffusion bioassays for the detection of antibiotic activity in body fluids: applications for the pneumonia etiology research for child health project","volume":"54 Suppl 2","author":"Driscoll","year":"2012","journal-title":"Clin Infect Dis"},{"key":"2024112509025592000_11.8.e050407.8","unstructured":"EDLIZ . 7th essential medicines list and standard treatment guidelines for Zimbabwe. The National Medicine and Therapeutics Policy Advisory Committee [NMTPAC], Ministry of Health & Child Welfare, Republic of Zimbabwe 2015."},{"key":"2024112509025592000_11.8.e050407.9","doi-asserted-by":"crossref","DOI":"10.1186\/s12879-017-2743-8","article-title":"Species distribution and antibiotic susceptibility profile of bacterial uropathogens among patients complaining urinary tract infections","volume":"17","author":"Bitew","year":"2017","journal-title":"BMC Infect Dis"},{"key":"2024112509025592000_11.8.e050407.10","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1302186"},{"key":"2024112509025592000_11.8.e050407.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2008.05.010"},{"key":"2024112509025592000_11.8.e050407.12","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.jinf.2018.07.001","article-title":"Global access to antibiotics without prescription in community pharmacies: a systematic review and meta-analysis","volume":"78","author":"Auta","year":"2019","journal-title":"J Infect"},{"key":"2024112509025592000_11.8.e050407.13","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1016\/j.eururo.2006.02.022","article-title":"EAU guidelines for the management of urogenital schistosomiasis","volume":"49","author":"Bichler","year":"2006","journal-title":"Eur Urol"},{"key":"2024112509025592000_11.8.e050407.14","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1038\/s41585-019-0228-9","article-title":"Urogenital tuberculosis - epidemiology, pathogenesis and clinical features","volume":"16","author":"Muneer","year":"2019","journal-title":"Nat Rev Urol"},{"key":"2024112509025592000_11.8.e050407.15","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp20X712781"},{"key":"2024112509025592000_11.8.e050407.16","unstructured":"Eucast . Eucast guidelines for detection of resistance mechanisms and specific resistances of clinical and\/or epidemiological importance version 2.01 July 2017. Available: https:\/\/eucast.org\/resistance_mechanisms\/"},{"key":"2024112509025592000_11.8.e050407.17","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1016\/j.afju.2016.11.005","article-title":"Antimicrobial susceptibility profile of community-acquired urinary tract infection in adults: a seven months prospective cross-sectional study in Dakar town, Senegal","volume":"23","author":"Barry","year":"2017","journal-title":"African Journal of Urology"},{"key":"2024112509025592000_11.8.e050407.18","doi-asserted-by":"publisher","DOI":"10.1086\/592250"},{"key":"2024112509025592000_11.8.e050407.19","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0210716","article-title":"A cross-sectional study on the prevalence of antibiotic use prior to laboratory tests at two Ghanaian hospitals","volume":"14","author":"Donkor","year":"2019","journal-title":"PLoS One"},{"key":"2024112509025592000_11.8.e050407.20","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1016\/j.scitotenv.2017.11.287","article-title":"Occurrence and risk assessment of antibiotics in water and lettuce in Ghana","volume":"622-623","author":"Azanu","year":"2018","journal-title":"Sci Total Environ"},{"key":"2024112509025592000_11.8.e050407.21","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.18.228486"},{"key":"2024112509025592000_11.8.e050407.22","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-018-3477-y"},{"key":"2024112509025592000_11.8.e050407.23","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1016\/S2352-4642(20)30335-7","article-title":"Uptake of and factors associated with testing for sexually transmitted infections in community-based settings among youth in Zimbabwe: a mixed-methods study","volume":"5","author":"Martin","year":"2021","journal-title":"Lancet Child Adolesc Health"},{"key":"2024112509025592000_11.8.e050407.24","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1111\/tmi.13274","article-title":"Community-based strategies to identify the unmet need for care of individuals with sexually transmitted infection-associated symptoms in rural South Africa","volume":"24","author":"Hoffman","year":"2019","journal-title":"Trop Med Int Health"},{"key":"2024112509025592000_11.8.e050407.25","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1177\/0956462420915395","article-title":"Partner notification and treatment outcomes among South African adolescents and young adults diagnosed with a sexually transmitted infection via laboratory-based screening","volume":"31","author":"Chitneni","year":"2020","journal-title":"Int J STD AIDS"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2021-050407","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,25]],"date-time":"2024-11-25T17:04:16Z","timestamp":1732554256000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2021-050407"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8]]},"references-count":25,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2021,8,11]]},"published-print":{"date-parts":[[2021,8]]}},"alternative-id":["10.1136\/bmjopen-2021-050407"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2021-050407","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8]]}}}