*2.2.8 Sexually transmitted disease*

Urine specimen is of valuable importance in the diagnosis of sexually transmitted diseases. Urinalysis can help in diagnosis of *Mycoplasma genitalium*, *Chlamydia*, *Neisseria gonorrhoeae*, *Trichomonas vaginalis*, and urethritis to name but a few. For example, leukocyte esterase dipstick test as a point-of-care diagnostic tool for urogenital *Chlamydia*, can be a valuable tool to accurately exclude *Chlamydia*. However, it shows low positive predictive value. Furthermore *Chlamydia trachomatis*, *Mycoplasma genitalium*, and *Neisseria gonorrhea* can be detected with PCR and real-time duplex PCR from urine samples [55–58]. Using urine as a specimen for diagnosis of Gonococcal infections by molecular tests has eased out uncomfortable sample collection by urethral swab and hence increased the number of patients volunteering to give specimen for this disease of public health importance.

### *2.2.9 Parasite detection in urine*

Urine microscopy and sediment test analysis help in the diagnosis of urinary parasites like *Schistosoma urinary egg detection.* However, egg detection method is below optimum and requires multiple samples; other methods for the detection of parasite in urine are being investigated. PCR shows promising results in this regards, and many papers are advocating for the clinical establishment of this method for detection of parasites such as *S. haematobium*, *Leishmania infantum*, *Trypanosoma* sp., and others [59–64].

#### **2.3 New technologies and urinalysis**

New technological advances have paved the way for significant progress in automated urinalysis [65]. Time and accuracy are the two key factors for diagnosis. In UTIs, urine dipsticks are very fast and easy to use, but it lacks the accuracy, whereas in the other hand, urine culture for antimicrobial susceptibility testing shows clinically reliable and accurate results, but it takes up to 3 days to give results. Many novel and improved diagnostic technologies and tools are introduced in the market, and some of them are already approved for clinical use and helped significantly in increasing the accuracy and decreasing the time of the test; a good example would be nucleic acid tests and mass spectrometry. Some other technologies show promising future such as the utilization of smartphone for urinalysis [65–68].

#### *2.3.1 Flow cytometry*

Recently flow cytometry is being introduced as a reliable method for fast diagnosis of UTIs by counting the bacteria in the urine specimen. With the improved counting precision over visual counting methods, highly accurate positive results can be obtained by this method. Detection of bacteriuria can be achieved with clinical standards using flow cytometry technology [69, 70].

#### *2.3.2 Test strip technology*

Major improvement in the test strip technology has been made in recent years. Not only highly sensitive test strips are being introduced, but also now, one can find strips, which give quantitative results for urinary proteins. The financial aspect is also

**193**

*Urine Tests for Diagnosis of Infectious Diseases and Antibiotic-Resistant Pathogens*

reduce the test time significantly from 2 to 3 days to few hours [73–75].

technology and pattern recognition technology [65, 76, 77].

of great importance, especially in the third world and developing countries; inexpensive test strips for various diagnostic reasons such as the diagnosis of diabetes form urine sample are available [71, 72]. Test strip method also shows promising result in antibiotic susceptibility tests; if optimum diagnostic requirement is reached, it can

Urine microscopy is one of the most important diagnostic methods for UTIs and other kidney diseases. Manual microscopy is time-consuming and can be labor extensive. Furthermore, with centrifugation decantation and re-suspension always lead to cell loss and cellular lysis. With the current available digital microscopy technologies, a significant time reduction can be archived with much more sample being processed in significantly short time in comparison to manual microscopy. In addition, with the ability to process uncentrifuged urine sample, issues like cell loss and lysis are of no more concern. Many automated analyzers are now available in the market with different kinds of technologies such as laminar flow digital imaging

The proteomic method "Matrix-assisted laser desorption ionization–time-offlight mass spectrometry (MALDI-TOF MS)" for identification of microorganisms directly from culture coupled with Gram stain has given new direction, saved considerable amount of time in diagnosis of UTI, and contributed greatly in the field of clinical microbiology in general. It can identify different pathogens accurately and significantly in short time. The utilization of this technology for the diagnosis of UTIs and furthermore in preforming antibiotic susceptibility tests to decrease the

Smartphone technologies improved the quality of life in countless fronts, and it has large potential for applications in the medical field. With point-of-care testing attracting much attention in recent years, smartphone solutions can be a valuable tool in this regard. It can, for example, increase the compliance of populations with screening programs by offering easy and fast screening method [80]. Studies exploring the possibility of establishing a smartphone-based diagnostic platform for rapid detection of Zika, chikungunya, and dengue viruses showed valuable prospective [20]. Several other smartphone applications utilizing urinalysis for various diagnostic reasons had been tested, and it shows promising future prospective which can greatly help both medical practitioners and patients alike [67, 81, 82].

The emergence of the antimicrobial resistant pathogen is worldwide issue threatening thousands if not millions of lives every year and with more and more strains developing not only a single drug resistance but also multidrug resistance (MDR) making the treatment of the disease much more complicated. Furthermore, many pathogens have developed resistance against a second-line or even last resort drugs. Recently the emergence of colistin-resistant strains attracted a lot of attention. Some of these resistant pathogens can cause serious illness or even death.

testing time from days to as fast as 2 hours can open wide doors [78, 79].

**3. Urine specimen and antibiotic-resistant pathogens**

*DOI: http://dx.doi.org/10.5772/intechopen.89231*

*2.3.3 Automated microscopy*

*2.3.4 MALDI-TOF*

*2.3.5 Urinalysis and smartphones*

#### *Urine Tests for Diagnosis of Infectious Diseases and Antibiotic-Resistant Pathogens DOI: http://dx.doi.org/10.5772/intechopen.89231*

of great importance, especially in the third world and developing countries; inexpensive test strips for various diagnostic reasons such as the diagnosis of diabetes form urine sample are available [71, 72]. Test strip method also shows promising result in antibiotic susceptibility tests; if optimum diagnostic requirement is reached, it can reduce the test time significantly from 2 to 3 days to few hours [73–75].

### *2.3.3 Automated microscopy*

*Pathogenic Bacteria*

can be a valuable diagnostic tool [22].

*2.2.8 Sexually transmitted disease*

*2.2.9 Parasite detection in urine*

*Trypanosoma* sp., and others [59–64].

**2.3 New technologies and urinalysis**

*2.3.1 Flow cytometry*

*2.3.2 Test strip technology*

This suggests that detection of Zika virus by real-time RT-PCR from urine specimen

Urine specimen is of valuable importance in the diagnosis of sexually transmitted diseases. Urinalysis can help in diagnosis of *Mycoplasma genitalium*, *Chlamydia*, *Neisseria gonorrhoeae*, *Trichomonas vaginalis*, and urethritis to name but a few. For example, leukocyte esterase dipstick test as a point-of-care diagnostic tool for urogenital *Chlamydia*, can be a valuable tool to accurately exclude *Chlamydia*. However, it shows low positive predictive value. Furthermore *Chlamydia trachomatis*, *Mycoplasma genitalium*, and *Neisseria gonorrhea* can be detected with PCR and real-time duplex PCR from urine samples [55–58]. Using urine as a specimen for diagnosis of Gonococcal infections by molecular tests has eased out uncomfortable sample collection by urethral swab and hence increased the number of patients volunteering to give specimen for this disease of public health importance.

Urine microscopy and sediment test analysis help in the diagnosis of urinary parasites like *Schistosoma urinary egg detection.* However, egg detection method is below optimum and requires multiple samples; other methods for the detection of parasite in urine are being investigated. PCR shows promising results in this regards, and many papers are advocating for the clinical establishment of this method for detection of parasites such as *S. haematobium*, *Leishmania infantum*,

New technological advances have paved the way for significant progress in automated urinalysis [65]. Time and accuracy are the two key factors for diagnosis. In UTIs, urine dipsticks are very fast and easy to use, but it lacks the accuracy, whereas in the other hand, urine culture for antimicrobial susceptibility testing shows clinically reliable and accurate results, but it takes up to 3 days to give results. Many novel and improved diagnostic technologies and tools are introduced in the market, and some of them are already approved for clinical use and helped significantly in increasing the accuracy and decreasing the time of the test; a good example would be nucleic acid tests and mass spectrometry. Some other technologies show promis-

Recently flow cytometry is being introduced as a reliable method for fast diagnosis of UTIs by counting the bacteria in the urine specimen. With the improved counting precision over visual counting methods, highly accurate positive results can be obtained by this method. Detection of bacteriuria can be achieved with clini-

Major improvement in the test strip technology has been made in recent years. Not only highly sensitive test strips are being introduced, but also now, one can find strips, which give quantitative results for urinary proteins. The financial aspect is also

ing future such as the utilization of smartphone for urinalysis [65–68].

cal standards using flow cytometry technology [69, 70].

**192**

Urine microscopy is one of the most important diagnostic methods for UTIs and other kidney diseases. Manual microscopy is time-consuming and can be labor extensive. Furthermore, with centrifugation decantation and re-suspension always lead to cell loss and cellular lysis. With the current available digital microscopy technologies, a significant time reduction can be archived with much more sample being processed in significantly short time in comparison to manual microscopy. In addition, with the ability to process uncentrifuged urine sample, issues like cell loss and lysis are of no more concern. Many automated analyzers are now available in the market with different kinds of technologies such as laminar flow digital imaging technology and pattern recognition technology [65, 76, 77].
