Best tests for UTI

What Is a UTI and What Are the Symptoms?

A urinary tract infection (UTI) is a common infection that occurs when bacteria enter the urinary system and multiply, causing inflammation and irritation. UTIs can affect any part of the urinary tract, but they most commonly involve the bladder (cystitis) or urethra (urethritis). The urinary system consists of the kidneys, ureters (tubes connecting the kidneys to the bladder), bladder, and urethra (the tube that carries urine out of the body).

Women are particularly susceptible to UTIs due to the anatomy of their urinary tracts. The female urethra is much shorter than the male urethra, making it easier for bacteria from the rectum or vagina to enter. It's estimated that about half of women will have at least one UTI in their life, and many will have recurrent infections.

The most common symptoms of a UTI include:

• A strong, persistent urge to urinate
• A burning sensation or pain when urinating
• Passing frequent, small amounts of urine
• Cloudy, dark, or strange-smelling urine
• Pelvic pain (especially in women)

Some people may also experience:

• Blood in the urine (hematuria)
• Pressure or cramping in the lower abdomen or back
• Fatigue and general feeling of being unwell
• Fever or chills (usually only with kidney infection)

While these are the most common signs, some people with UTIs may not experience any obvious symptoms. This is more likely in older adults or those with certain medical conditions like diabetes or spinal cord injuries.

If a UTI is left untreated, it can spread to the kidneys (pyelonephritis), potentially causing permanent damage and even life-threatening complications like sepsis. Kidney infections often cause additional symptoms like high fever, nausea, vomiting, and severe back or side pain. If you suspect a kidney infection, visit a healthcare provider right away.

Common Tests for Diagnosing UTIs

When you see a healthcare provider with symptoms of a UTI, they will likely recommend at least one diagnostic test to make sure you get the appropriate care. The most common tests for diagnosing UTIs include:

Urinalysis

A urinalysis is a simple test that looks at the physical, chemical, and microscopic properties of a urine sample. For this test, you will be asked to urinate into a sterile container midstream.

The sample is then analyzed for signs of infection, such as:

• Presence of white blood cells (leukocytes), which fight infection
• Nitrites, a byproduct of certain bacteria
• Red blood cells, which can indicate inflammation
• Protein, glucose, or other substances at abnormal levels

While a urinalysis can generally confirm a UTI, it cannot identify the specific bacteria causing the infection.

Urine culture

If the urinalysis suggests a UTI, your healthcare provider may order a urine culture to figure out the exact type of bacteria involved. This information helps your healthcare provider choose an antibiotic.

Cultures can also help rule out less common causes of UTI-like symptoms, such as sexually transmitted infections or bladder cancer.

Additional tests for recurrent or complicated UTIs

For most UTIs, a urinalysis and culture are enough to diagnose and treat. However, if you have recurrent UTIs (2 or more in 6 months or 3 or more in a year) or other complicating factors, your healthcare provider may recommend additional tests.

Imaging tests like ultrasounds, CT scans, or MRIs can help your healthcare provider see the urinary tract and identify any structural abnormalities, blockages, or kidney stones that may be contributing to recurrent infections.

In some cases, a cystoscopy may be performed. This involves inserting a thin, flexible tube with a camera (cystoscope) through the urethra to directly examine the bladder lining for signs of inflammation, tumors, or other irregularities.

While over-the-counter UTI test strips are available, they are not a substitute for professional medical evaluation. Home test strips can be inaccurate and do not provide the detailed information needed for proper diagnosis and treatment. If you suspect you have a UTI, it's always best to consult with a healthcare provider.

Preventing and Treating Recurrent UTIs

Recurrent urinary tract infections (UTIs) are a frustrating and often painful problem. While anyone can experience recurrent UTIs, certain factors increase the risk, such as:

• A history of UTIs, particularly in childhood or adolescence
• Menopause and associated hormonal changes
• Frequent sexual activity
• Use of spermicides or diaphragms for birth control
• Anatomical abnormalities in the urinary tract
• Certain medical conditions, like diabetes or bladder stones

Traditional prevention methods

The main approach to preventing recurrent UTIs has been low-dose antibiotic prophylaxis (using antibiotics to prevent rather than treat an infection). This involves taking a small dose of antibiotics daily, after sexual activity, or at the first sign of UTI symptoms.

Non-antibiotic prevention

One of the most well-known non-antibiotic approaches to UTI prevention is the using cranberry products. Cranberries have compounds called proanthocyanidins that can help prevent bacteria from sticking to the bladder wall, reducing the risk of infection. Some studies have shown that consuming cranberry juice or supplements regularly can decrease UTI recurrence, particularly in women with a history of frequent infections.

Probiotics are another promising option for UTI prevention. These beneficial bacteria help maintain a healthy balance of microorganisms in the urinary tract and vagina by beating out harmful bacteria for resources and preventing overgrowth.

Lifestyle changes can also play a role in UTI prevention. These include:

• Staying well-hydrated to flush bacteria from the urinary tract
• Urinating after sexual activity
• Wiping from front to back after using the bathroom
• Avoiding irritating feminine products, like douches or scented tampons
• Wearing breathable, cotton underwear and avoiding tight-fitting clothing

For postmenopausal women, vaginal estrogen therapy may help prevent recurrent UTIs. The drop in estrogen levels after menopause can thin and dry the vaginal and urethral tissues, making it easier for bacteria to develop. Applying low-dose estrogen directly to the vagina can help restore the protective mucus layer and reduce UTI risk.

When To See a Doctor for a UTI

While mild UTIs may sometimes resolve on their own, it's generally best to see a healthcare provider if you think you have an infection. Quick treatment can prevent the infection from spreading and causing more serious complications.

Conclusion

Urinary tract infections can cause painful symptoms and may lead to serious complications if left untreated. Fortunately, there are effective tests and treatments available to diagnose and manage UTIs.

It's important to see a healthcare provider at the first sign of a UTI, especially if you have a higher risk of complications. Prompt diagnosis and treatment can relieve symptoms, prevent the infection from spreading, and reduce the chances of recurrence.

Citations:

<1>Bates, B. N., & Bates, B. N. (2013). Interpretation of Urinalysis and Urine Culture for UTI Treatment. US Pharm, 38(11), 65-68.</1>

<2>Meckes, M. C., Wald, E. R., & Hendley, J. O. (2019). Urine Culture: Reference Range, Interpretation, Collection and Panels. Medscape.</2>

<3>Sequeira-Antunes, B., & Ferreira, H. A. (2023). Urinary biomarkers and point-of-care urinalysis devices for early diagnosis and management of disease: A review. Diagnostics, 13(3), 468. https://doi.org/10.3390/diagnostics13030468</3>

<4>Akhlaghpour, M., Haley, E., Parnell, L., Luke, N., Mathur, M., Festa, R. A., ... & Anderson, L. (2024). Urine biomarkers individually and as a consensus model show high sensitivity and specificity for detecting UTIs. BMC Infectious Diseases, 24(1), 153. https://doi.org/10.1186/s12879-024-09044-2</4>

<5>Sequeira-Antunes, B., & Ferreira, H. A. (2023). Biomarkers of urinary tract infections: state of the art, and promising applications for rapid strip-based chemical sensors. Analytical Methods, 7(15), 6577-6588. https://doi.org/10.1039/C5AY01678A</5>

<6>Akhlaghpour, M., Haley, E., Parnell, L., Luke, N., Mathur, M., Festa, R. A., ... & Anderson, L. (2024). Elevated UTI Biomarkers in Symptomatic Patients with Urine Microbial Densities of 10,000 CFU/mL Indicate a Lower Threshold for Diagnosing UTIs. BMC Infectious Diseases, 24(1), 153. https://doi.org/10.1186/s12879-024-09044-2</6>

<7>Diagnostic value of biomarkers for paediatric urinary tract infections in primary care: systematic review and meta-analysis. (2021). BMC Primary Care, 22(1), 1-15. https://doi.org/10.1186/s12875-021-01530-9</7>

<8>Anger J, Lee U, Ackerman AL, Chou R, Chughtai B, Clemens JQ, Hickling D, Kapoor A, Kenton KS, Kaufman MR, Rondanina R, Stapleton A, Stothers L, Sussman DO, Zuckerman JM. Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline (2019). The Journal of Urology. 2019 May;201(5):982-990. doi: 10.1097/JU.0000000000000296. Epub 2019 Feb 12. PMID: 30785603.</8>

<9>Hayward G, Mort S, Hay AD, Moore M, Thomas NPB, Cook J, Robinson J, Williams N, Maeder N, Edeson R, Franssen M, Grabey J, Glogowska M, Yang Y, Allen J, Butler CC. D-Mannose for Prevention of Recurrent Urinary Tract Infection Among Women: A Randomized Clinical Trial. JAMA Internal Medicine. 2024 Apr 08;184(7):623-631. doi: 10.1001/jamainternmed.2024.0776. PMID: 38587819; PMCID: PMC11002776.</9>

<10>Smith AL, Brown J, Wyman JF, Berry A, Newman DK, Stapleton AE. Treatment and Prevention of Recurrent Lower Urinary Tract Infections in Women: A Rapid Review with Practice Recommendations. The Journal of Urology. 2018 Dec;200(6):1174-1191. doi: 10.1016/j.juro.2018.04.085. Epub 2018 May 4. PMID: 29940246.</10>

<11>Cameron AP, Castrodad PM, Troost J, Forchheimer M, Tate DG. Effectiveness and patient perspective on the use of intravesical gentamicin instillations to treat recurrent urinary tract infections in neurogenic lower urinary tract dysfunction. Neurourology and Urodynamics. 2023;42(3):443-450. doi: 10.1002/nau.24991. Epub 2023 Jan 25. PMID: 36695852.</11>

<12>Xiangchen GU, Meisi Q, Lin X, Min C, Yueyi D, Changming Z, Guihua J, Chen W, Yi W. Individualized Traditional Chinese Medicine treatment antibiotics for recurrent urinary tract infections: a multicenter, randomized controlled study. Phytomedicine. 2023 Jul 1;101:154416. doi: 10.1016/j.phymed.2023.154416. Epub 2023 May 15. PMID: 36695860.</12>

<13>Bader, M. S., Loeb, M., & Brooks, A. A. (2017). An update on the management of urinary tract infections in the era of antimicrobial resistance. Postgraduate Medicine, 129(2), 242-258. https://doi.org/10.1080/00325481.2017.1246055</13>

<14>El-Lababidi, R. M., & Rizk, J. G. (2020). Cefiderocol: A Siderophore Cephalosporin. The Annals of Pharmacotherapy, 54(12), 1215-1231. https://doi.org/10.1177/1060028020929988</14>

<15>Flores-Mireles, A. L., Walker, J. N., Caparon, M., & Hultgren, S. J. (2015). Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nature Reviews Microbiology, 13(5), 269-284. https://doi.org/10.1038/nrmicro3432</15>

<16>Concia, E., Bragantini, D., & Mazzaferri, F. (2017). Clinical evaluation of guidelines and therapeutic approaches in multi drug-resistant urinary tract infections. Journal of Chemotherapy, 29(sup1), 19-28. https://doi.org/10.1080/1120009X.2017.1380397</16>

<17>Harding, C., Mossop, H., Homer, T., Sims, E., Walton, K., Anson, K., ... & Pickard, R. (2022). Alternative to prophylactic antibiotics for the treatment of recurrent urinary tract infections in women: multicentre, open label, randomised, non-inferiority trial. BMJ, 376, e068229. https://doi.org/10.1136/bmj-2021-068229</17>

<18>Walter E. Stamm, Raul Raz, Factors Contributing to Susceptibility of Postmenopausal Women to Recurrent Urinary Tract Infections, Clinical Infectious Diseases, Volume 28, Issue 4, April 1999, Pages 723–725, https://doi.org/10.1086/515209</18>

<19>Geng L, Huang W, Jiang S, et al. "Effect of Menopausal Hormone Therapy on the Vaginal Microbiota and Genitourinary Syndrome of Menopause in Chinese Menopausal Women." Front Microbiol. 2019;10:1770. Published 2019 Aug 7. doi:10.3389/fmicb.2019.01770</19>

<20>Hooton TM, Scholes D, Hughes JP, Winter C, Roberts PL, Stapleton AE, et al. A prospective study of risk factors for symptomatic urinary tract infection in young women. N Engl J Med. 1996;335(7):468-74. doi: 10.1056/NEJM199608153350703. PMID: 8672152.</20>

<21>Kannady, C. (2022). When to See a Doctor for a Urinary Tract Infection (UTI). Houston Methodist On Health. https://www.houstonmethodist.org/blog/articles/2022/apr/when-to-see-a-doctor-for-a-urinary-tract-infection-uti/</21>

<22>WebMD. (n.d.). Remedies for UTI: What to Do and When to See a Doctor. https://www.webmd.com/a-to-z-guides/remedies-uti</22>

<23>HealthLink BC. (n.d.). Urinary Tract Infections in Teenagers and Adults. https://www.healthlinkbc.ca/health-topics/urinary-tract-infections-teenagers-and-adults</23>

<24>healthdirect. (n.d.). Urinary tract infection (UTI) - symptoms, treatment and prevention. https://www.healthdirect.gov.au/urinary-tract-infection-uti</24>

<25>NewMed Immediate Care. (n.d.). When to See a Doctor About a UTI. https://www.newmedimmediatecare.com/blog/when-to-see-a-doctor-about-a-uti</25>

<26>UnityPoint Health. (n.d.). Can UTIs Go Away on Their Own?. https://www.unitypoint.org/news-and-articles/can-utis-go-away-on-their-own</26>

<27>Hooton, T. M., Gupta, K., & Naber, K. G. (2010). Management of uncomplicated urinary tract infections. Clinical Infectious Diseases, 52(5), 1-7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071654/</27>

<28>Beerepoot, M. A., Geerlings, S. E., van Haarst, E. P., van Charante, N. M., & ter Riet, G. (2013). Nonantibiotic prophylaxis for recurrent urinary tract infections: a systematic review and meta-analysis of randomized controlled trials. The Journal of urology, 190(6), 1981-1989.</28>

<29>Flores-Mireles, A. L., Walker, J. N., Caparon, M., & Hultgren, S. J. (2015). Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nature reviews microbiology, 13(5), 269-284.</29>

<30>Schmiemann, G., Kniehl, E., Gebhardt, K., Matejczyk, M. M., & Hummers-Pradier, E. (2010). The diagnosis of urinary tract infection: a systematic review. Deutsches Ärzteblatt International, 107(21), 361.</30>

<31>Cai, T., Mazzoli, S., Mondaini, N., Meacci, F., Nesi, G., D'Elia, C., ... & Bartoletti, R. (2012). The role of asymptomatic bacteriuria in young women with recurrent urinary tract infections: to treat or not to treat?. Clinical Infectious Diseases, 55(6), 771-777.</31>

<32>Harding, G. K., Zhanel, G. G., Nicolle, L. E., & Cheang, M. (2002). Antimicrobial treatment in diabetic women with asymptomatic bacteriuria. New England Journal of Medicine, 347(20), 1576-1583.</32>

<33>Hooton, T. M. (2012). Uncomplicated urinary tract infection. New England Journal of Medicine, 366(11), 1028-1037.</33>

<34>Foxman, B. (2010). The epidemiology of urinary tract infection. Nature Reviews Urology, 7(12), 653-660.</34>

<35>Gupta, K., Hooton, T. M., Naber, K. G., Wullt, B., Colgan, R., Miller, L. G., ... & Soper, D. E. (2011). International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clinical infectious diseases, 52(5), e103-e120.</35>