Evaluating the Misdiagnosis of Sexually Transmitted Diseases in Hong Kong's Outpatient Healthcare Sector

Background and Objective: Timely and accurate diagnosis plays a pivotal role in the successful management of diseases. However, delayed diagnosis or misdiagnosis continue to be significant concerns, resulting in adverse effects on patient treatment outcomes. Sexually transmitted diseases (STDs) are among the most prevalent infectious diseases globally, with over one million new cases acquired daily. The presence of misdiagnosis in STD cases cannot be ignored. The objective of the present study is to determine the rate of misdiagnosis of STDs and investigate the underlying factors contributing to this issue.

Methods: Specimens for STD diagnosis were collected from multiple clinics and hospitals between June 1, 2021, and October 20, 2021. The DNA extraction process utilized a magnetic bead-based method, followed by testing the extracted DNA using the DiagCor GenoFlowTM STD Array Test Kit to identify targeted pathogens.

Results: During the specified time, a total of 1459 specimens were collected and included in the study. Among these, 643 specimens tested positive for at least one targeted STD pathogen. Out of the positive cases, 494 were aligned with the tests ordered by physicians, while the remaining 149 positive cases had at least one pathogen detected that was not requested to be tested, leading to misdiagnosis. The overall misdiagnosis rate was determined to be 23.2% (149 out of 643), with a higher frequency of misdiagnosis observed in tests ordered for the detection of one to three pathogens. It is worth noting that Ureaplasma urealyticum and/or Ureaplasma parvum (UU/UP) were the most detected pathogens in this study.

Conclusion: The study's findings emphasize that incorrect test selection by physicians is a major contributor to misdiagnosis in outpatient settings for STD cases. To mitigate diagnostic errors in STD diagnosis, it is crucial for physicians to meticulously choose and request tests that enable the detection of multiple pathogens. Co-infections involving multiple pathogens are commonly encountered among STD patients. Optimal test selection not only benefits individual patients but also has wider implications for public health.

Expanding upon these findings, this chapter delves into the challenges associated with STD misdiagnosis, explores the potential consequences for patients and public health, and provides strategies and recommendations for improving diagnostic accuracy in outpatient settings. The discussion emphasizes the importance of comprehensive testing approaches that encompass multiple pathogens to address the complexity of STD infections effectively. Furthermore, the chapter highlights the significance of clinician education and awareness regarding appropriate test selection, emphasizing the need for ongoing professional development and updated guidelines in the field of STD diagnosis. By addressing these issues, we can enhance diagnostic practices, reduce misdiagnosis rates, and ultimately improve patient care and public health outcomes in the context of sexually transmitted diseases.