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Best tests for UTI

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Written by Andrew Le, MD.
Medically reviewed by
Clinical Physician Assistant, Summit Health
Last updated June 20, 2024

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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.

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Clinical Physician Assistant, Summit Health
Jeff brings to Buoy 20 years of clinical experience as a physician assistant in urgent care and internal medicine. He also has extensive experience in healthcare administration, most recently as developer and director of an urgent care center. While completing his doctorate in Health Sciences at A.T. Still University, Jeff studied population health, healthcare systems, and evidence-based medicine....
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