Three Conditions Often Mistaken for STDs (.. and Vice Versa)

When a person has weird symptoms going on "down there", the only real way to be certain what's going on is to head to the doctor for testing. Unfortunately, sometimes even that isn't enough. There are several conditions that are commonly misdiagnosed as STDs, and vice versa, based on how similar their symptoms are. That's why, if a doctor tries to diagnose your painful urination, genital itching, or related symptoms without tests or an exam, you might want to ask for a second opinion. The medications used for STDs are different than the ones used for other conditions, and getting the wrong drugs can be actively harmful to improving your health -- particularly if they encourage the growth of antibiotic resistant bacteria.

1
Urinary Tract Infections (UTIs)

Urine Test Cup
Urine Test Cup. Ann Cutting/Photographer's Choice/Getty Images

In the summer of 2015, a study was published which showed, quite clearly, how often UTIs and STDs are misdiagnosed. The study, which looked at 265 women who came into an urban emergency room with genitourinary symptoms found that 66 percent of those women were diagnosed with a UTI. Unfortunately, less than half of those diagnosed women actually had a UTI.

The problem was that doctors weren't routinely performing urine cultures or other tests that could correctly distinguish between UTIs and STDs. That not only meant that many STI cases were either missed or treated improperly, while other women received antibiotics who didn't need them. It's a useful reminder that syndromatic treatment doesn't work and that genitourinary symptoms can't be diagnosed properly unless doctors use more specific tests.

Sources:

Tomas ME, Getman D, Donskey CJ, Hecker MT. Overdiagnosis of Urinary Tract Infection and Underdiagnosis of Sexually Transmitted Infection in Adult Women Presenting to an Emergency Department. J Clin Microbiol. 2015 Aug;53(8):2686-92. doi: 10.1128/JCM.00670-15.

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2
Yeast Infections

Light micrograph of Candida albicans, yeast.
LIGHT MICROGRAPH OF CANDIDA ALBICANS. YEAST CELLS WITH FILAMENTOUS HYPHAE AND PSEUDOHYPHAE. 200X. Alfred Pasieka/Photo Library/Getty Images

Yeast infections are another source of genito-urinary symptoms that are relatively commonly misdiagnosed. To an extent people who have had yeast infections are reasonably good at recognizing them and treating them, which is why over the counter treatments are so widely available. However, self-diagnosis is far from foolproof. That's why doctors generally suggest that women seek out testing when self-treatment doesn't work or when symptoms reappear repeatedly after treatment.

It's also worth mentioning that not all physician tests for yeast infections are created equal. Wet mounts, which use a microscope to look for the presence of yeast or other organisms in a vaginal smear, have been shown to be far less reliable in detecting yeast infections than have culture based tests.

Sources:

Hoffstetter SE, Barr S, LeFevre C, Leong FC, Leet T. Self-reported yeast symptoms compared with clinical wet mount analysis and vaginal yeast culture in a specialty clinic setting. J Reprod Med. 2008 Jun;53(6):402-6.

Schwiertz A, Taras D, Rusch K, Rusch V. Throwing the dice for the diagnosis of vaginal complaints? Ann Clin Microbiol Antimicrob. 2006 Feb 17;5:4.

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3
Bacterial Vaginosis (BV)

Clue cells are vaginal epithelial cells that are covered in bacteria. They are one way of diagnosing bacterial vaginosis. Photo Courtesy of the Public Health Image Library; CDC/M. Rein

BV is something of a weird condition. The symptoms are heavily associated with sexual behaviors, but it doesn't appear to be sexually transmitted. (At least not all the time. There is some evidence for sexual transmission in women who have sex with women.) It is, more than anything, a disruption of the normal vaginal flora, and many doctors and researchers aren't certain when it's important to treat it -- let alone the best way of doing so.

As such, diagnosis and treatment of BV are important -- in as much to reduce the risk of problematic outcomes such as coinfection or preterm birth as to deal with BV infections themselves -- but tricky. It's essential to balance detecting active cases with not over-detecting asymptomatic ones.

Unfortunately, it's not yet clear where that line lies. What is clear, however, is that women who are diagnosed with BV should also be tested for other vaginal infections. BV is associated with an increased risk of not just STDs, but the conditions listed above.

Sources:

Allsworth JE, Peipert JF. Severity of bacterial vaginosis and the risk of  sexually transmitted infection. Am J Obstet Gynecol. 2011 Aug;205(2):113.e1-6. doi: 10.1016/j.ajog.2011.02.060.

Gallo MF, Macaluso M, Warner L, Fleenor ME, Hook EW 3rd, Brill I, Weaver MA. Bacterial vaginosis, gonorrhea, and chlamydial infection among women attending a sexually transmitted disease clinic: a longitudinal analysis of possible causal links. Ann Epidemiol. 2012 Mar;22(3):213-20. doi: 10.1016/j.annepidem.2011.11.005.

Koumans EH, Markowitz LE, Hogan V; CDC BV Working Group. Indications for therapy and treatment recommendations for bacterial vaginosis in nonpregnant and pregnant women: a synthesis of data. Clin Infect Dis. 2002 Oct 15;35(Suppl 2):S152-72.

Marrazzo JM. Interpreting the epidemiology and natural history of bacterial vaginosis: are we still confused? Anaerobe. 2011 Aug;17(4):186-90. doi: 10.1016/j.anaerobe.2011.03.016.

Rivers CA, Adaramola OO, Schwebke JR. Prevalence of bacterial vaginosis and vulvovaginal candidiasis mixed infection in a southeastern american STD clinic. Sex Transm Dis. 2011 Jul;38(7):672-4. doi: 10.1097/OLQ.0b013e31820fc3b8.

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Sexually Transmitted vs. Sexually Associated

It is worth noting that all three of the conditions commonly confused with STDs are sexually associated, if not sexually transmitted. It's possible that that may confuse things from a behavioral standpoint, although not a biological one. That said, it's also important for doctors to assess sexual behavior in detail. After all, condom use is pretty good at preventing STDs, but for some people it's actually associated with an increased risk of other genitourinary conditions.

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