Online Misinformation on UTIs, ASB is Common and Dangerous: New Research

A recent study evaluating the quality of online information about urinary tract infections (UTIs) revealed a discouraging mix of accurate and inaccurate content.

In an evaluation of 331 websites, a research team from the CDC Prevention Epicenters Program found that while nearly all sites (97%) correctly identified at least 1 UTI symptom, 80% also included inaccurate symptoms, with 74% citing changes in urine color and 69% referencing strong-smelling urine—neither of which are reliable indicators of a UTI, according to corresponding author Mary C Politi, PhD, Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St Louis, and colleagues.¹

Writing in JAMA Network Open, Politi et al also reported inaccurate and misleading information regarding asymptomatic bacteriuria (ASB), defined as the presence of bacteria in the urine without evidence of UTI. ASB is common and benign in most populations. Only 9% of websites mentioned ASB, and just 3% correctly noted that symptoms must be present for a true UTI diagnosis, according to the study. Alarmingly, researchers found just 1 in 5 (21%) of the websites reviewed mentioned antibiotic resistance among individuals. Moreover, only 9% discussed the problem of global antibiotic resistance and just 8% warned of adverse reactions to antibiotics.¹

The authors cite recent data from the National Center for Health Statistics that estimate more than 80% of US adults search the internet for health-related information.² “Websites with unclear information or misinformation about UTIs and ASB may influence patients’ expectations for treatment of symptoms not consistent with UTIs,” they wrote. AI-generated summaries of internet information may also be misleading. The inaccurate information, the team cautioned, was “biased toward overtreatment,” raising concern for perpetuation of both individual and widespread antibiotic resistance.¹

“Websites with unclear information or misinformation about UTIs and ASB may influence patients’ expectations for treatment of symptoms not consistent with UTIs."

ASB is often overtreated and particularly in older adults, the result of challenges in distinguishing ASB from UTIs.³ Prevalence rates vary, with studies reporting ASB in over 15% of older women and up to 50% of women in long-term care facilities.³ While ASB is usually harmless and does not typically progress to UTIs, unnecessary treatment provides no clinical benefit for most populations and can lead to adverse outcomes.

Current IDSA guidelines recommend screening and treating ASB in two populations: pregnant women in the first trimester (to reduce the risk of pyelonephritis and poor pregnancy outcomes) and patients undergoing urologic procedures with mucosal trauma.³ In the absence of symptoms, routine screening is not recommended in groups including patients with diabetes, spinal cord injuries, neutropenia, or indwelling urinary catheters.³

The risks associated with over-treatment of ASB include Clostridioides difficile infection, increased antimicrobial resistance, and unnecessary healthcare costs. To address this issue, many US antibiotic stewardship programs have implemented protocols to specifically reduce inappropriate ASB treatment, aligning with global efforts to combat antimicrobial misuse.³

Politi and colleagues conducted Google searches for UTIs in incognito mode between December 2023 and January 2024. The search terms were developed collaboratively by a team of clinicians specializing in geriatrics and infectious diseases, along with a community advisory board comprising older adults and patient advocates, ensuring terms were both relevant and comprehensive for identifying online content about UTIs and ASB.¹

Websites met Inclusion criteria if they were freely accessible, written in English, based in the United States, and tailored for adult, nonpregnant individuals. The identified 1,413 websites. After exclusions, 331 websites were included in the detailed evaluation.

Quality of information on each website was assessed using a structured codebook developed and refined by the study team and clinical advisors. According to the study, 20% of the websites were double-coded to ensure reliability and consistency. Descriptive statistics, including frequencies and percentages, were then used to summarize the data and quantify the prevalence of accurate and inaccurate information.¹

While this study specifically examined UTIs, the findings highlight a broader issue with the accuracy of online health information, wrote study authors. Clinicians, being a primary and trusted source of information for patients, play an essential role in addressing this challenge when they offer clear, evidence-based guidance and direct patients to trustworthy sources. Politi and colleagues also called on researchers to develop methods to identify and correct inaccuracies in online content to work toward optimizing AI algorithms to prioritize reliable health resources.

References
1. Schmitz V, Troubh Z, Durkin M, et al. Quality of publicly available information about urinary tract infections. JAMA Netw Open. 2024;7(11):e2444988. doi:10.1001/jamanetworkopen.2024.44988
2. National Center for Health Statistics. Data Brief 482. Health information technology use among adults: United States, July-December 2022. Centers for Disease Control and Prevention. October 2023. Accessed November 22, 2024. https://www.cdc.gov/nchs/data/databriefs/db482-tables.pdf#1
3. Luu T, Albarillo FS. Asymptomatic bacteriuria: prevalence, diagnosis, management, and current antimicrobial stewardship implementations. Am J Med. 2022;135(8):e236-e244. doi:10.1016/j.amjmed.2022.03.015