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UTI Testing - Why Does It Matter?

Dr. Mara Holton and Kathleen Mackey
Dr. Mara Holton and Kathleen Mackey
December 12, 2022
•
3
min read
UTI Testing - Why Does It Matter?

If you have ever had a Urinary Tract Infection (UTI), the article headline above probably does not surprise you. While many common infectious diseases, like sinus infections and upper respiratory infections, are often treated empirically (without specific organism identification), there is overwhelming evidence that UTIs and STIs are incorrectly treated more than half of the time (Lamott, 2021). Health care providers may base their diagnosis of UTI on a number of tests; understanding the benefits and limitations of each test can help ensure your infection is quickly diagnosed and properly treated.  

Diagnosis of UTI

Three commonly used tests that aid in the diagnosis of a UTI are: 1) Dipstick urinalysis test, 2) Urine culture, and 3) Urine PCR.

Dipstick Urinalysis:

  • Detects the presence of blood, nitrite, and white blood cells but NOT specific bacteria.
  • The presence of these types of cells *may* indicate an infection; these findings could be caused by other problems such as kidney stones, urologic cancers, vaginal contamination, or infection.  
  • False positives lead to inappropriate use of antibiotics and potentially missed diagnoses.

Urine culture:

  • “Gold standard” of UTI testing. Actually, only detects about 73% of UTIs.  This means that in over 25% of cases, the patient WILL have a UTI despite a negative culture.  
  • Often does not detect all organisms when there are multiple present.
  • Results can take 2-10 days

Urine PCR:

  • Extremely accurate – amplifies bacterial DNA in the urine.
  • Results in as little as  6-8 hours once getting to the testing site.
  • Only tests for organisms on the designated panel; it is important to use clinical expertise when interpreting
  • Detects the presence of resistance genes to antibiotics.

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Dipsticks and questionnaires may help you figure out the likelihood that symptoms are related to a UTI or STI, but definitive organism identification is a crucial component of choosing the correct antibiotic or therapy. A provider that understands the advantages and limitations of each test is key!

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About the Authors:

Dr. Mara Holton and Kathleen Mackey first met in 2007 while practicing general urology with a large local urology group.  At the time, Dr. Holton had just recently completed her urologic residency at the University of Maryland, and Kathleen had been in practice with the group as a CRNP for just over a year.  

Although both practiced general urology, over the years, the majority of their patient population became women experiencing recurrent urinary tract infections, urinary incontinence, uncomfortable vaginal symptoms, and difficulty with sexual activity.  They quickly found a common theme that many women had experienced these symptoms for years prior to identifying a provider who could address their concerns.  Unfortunately, many patients recounted that, when they did seek help, they were often undertreated, misdiagnosed, or led to believe their symptoms were just something that had to be tolerated. Many women described scenarios of being brushed off by male providers or told that their symptoms were a normal part of aging. As active women and mothers themselves, Mara & Kathleen empathized with the burden these conditions caused and the associated negative impacts on the quality and enjoyment of life.  In developing Snippa, a female-focused health care platform,  Mara and Kathleen seek to broaden and expand their reach and efforts in order to educate patients about pelvic health and to advocate for access to care, research into , and the development of treatment alternatives for these prevalent health conditions.

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References
  1. Ahmed, S., Alsalloom, A, Babikir, I., Alhoumoud, B. (2019). Uropathogens and their antimicrobialvpatterns: Relationship with urinary tract infections. International Journal of Health Sciences. 2019 Mar-Apr; 12 (2): 48-55.
  2. Chua, K.-P., Fischer, M. A., & Linder, J. A. (2019). Appropriateness of outpatient antibiotic prescribing among privately insured US patients: ICD-10-CM based Cross Sectional Study. BMJ.
  3. Davenport M, Mach KE, Shortliffe LMD, Banaei N, Wang TH, Liao JC. New and developing diagnostic technologies for urinary tract infections. Nat Rev Urol. 2017;14(5):296-310.
  4. García LT, Cristancho LM, Vera EP, Begambre O. A New Multiplex-PCR for Urinary Tract Pathogen Detection Using Primer Design Based on an Evolutionary Computation Method. J Microbiol Biotechnol. 2015 Oct;25(10):1714-27.
  5. LaMotte, S. (2021, February 24). Doctors treat female UTIs with wrong antibiotics nearly half the time, study finds. CNN. Retrieved Dec 11, 2022.
  6. Mambatta, A. K., Jayarajan, J., Rashme, V. L., Harini, S., Menon, S., & Kuppusamy, J. (2015). Reliability of dipstick assay in predicting urinary tract infection. Journal of family medicine and primary care, 4(2), 265–268.
About the Author
Dr. Mara Holton and Kathleen Mackey

Dr. Mara Holton and Kathleen Mackey first met in 2007 while practicing general urology with a large local urology group.  At the time, Dr. Holton had just recently completed her urologic residency at the University of Maryland, and Kathleen had been in practice with the group as a CRNP for just over a year.  

Although both practiced general urology, over the years, the majority of their patient population became women experiencing recurrent urinary tract infections, urinary incontinence, uncomfortable vaginal symptoms, and difficulty with sexual activity.  They quickly found a common theme that many women had experienced these symptoms for years prior to identifying a provider who could address their concerns.  Unfortunately, many patients recounted that, when they did seek help, they were often undertreated, misdiagnosed, or led to believe their symptoms were just something that had to be tolerated. Many women described scenarios of being brushed off by male providers or told that their symptoms were a normal part of aging. As active women and mothers themselves, Mara & Kathleen empathized with the burden these conditions caused and the associated negative impacts on the quality and enjoyment of life.  In developing Snippa, a female-focused health care platform,  Mara and Kathleen seek to broaden and expand their reach and efforts in order to educate patients about pelvic health and to advocate for access to care, research into , and the development of treatment alternatives for these prevalent health conditions.

About the Reviewer
This blog was
Medically reviewed by:
Dr. Mara Holton and Kathleen Mackey

Dr. Mara Holton and Kathleen Mackey first met in 2007 while practicing general urology with a large local urology group.  At the time, Dr. Holton had just recently completed her urologic residency at the University of Maryland, and Kathleen had been in practice with the group as a CRNP for just over a year.  

Although both practiced general urology, over the years, the majority of their patient population became women experiencing recurrent urinary tract infections, urinary incontinence, uncomfortable vaginal symptoms, and difficulty with sexual activity.  They quickly found a common theme that many women had experienced these symptoms for years prior to identifying a provider who could address their concerns.  Unfortunately, many patients recounted that, when they did seek help, they were often undertreated, misdiagnosed, or led to believe their symptoms were just something that had to be tolerated. Many women described scenarios of being brushed off by male providers or told that their symptoms were a normal part of aging. As active women and mothers themselves, Mara & Kathleen empathized with the burden these conditions caused and the associated negative impacts on the quality and enjoyment of life.  In developing Snippa, a female-focused health care platform,  Mara and Kathleen seek to broaden and expand their reach and efforts in order to educate patients about pelvic health and to advocate for access to care, research into , and the development of treatment alternatives for these prevalent health conditions.

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