I have uti symptoms but no uti

Urology > General Urology

— Can't count on culture findings to rule out infection

by Staff Writer, MedPage Today April 28, 2017

Almost all women who exhibited symptoms of a urinary tract infection, but had a negative urine culture, actually had an infection, a small Belgian study found.

Overall, 90.5% of symptomatic women with a negative urine culture tested positive for Escherichia coli bacteria with molecular methods compared to about 5.3% of women without symptoms (Fisher's exact test; P<0.00001), reported Stefan Heytens, MD, of Ghent University in Belgium, and colleagues, writing in Clinical Microbiology and Infection.

The authors said that dysuria, frequency and urgency are "highly predictive" of a urinary tract infection in women, and "therapy can be empirically started without performing a culture in women with symptoms of an uncomplicated UTI." But they added that around a quarter of women with symptoms will have a negative urine culture, because prior research found the threshold for diagnosing an uncomplicated urinary tract infection may be too high.

"A substantial percentage of women visiting their GP with symptoms of a UTI, who test negative for a bacterial infection, are told they have no infection and sent home without treatment," Heytens said in a statement. "Our findings support previous research which indicates that traditional testing may not be helpful in uncomplicated UTIs."

Researchers examined 220 symptomatic women (dysuria and/or frequency/urgency) and 86 women without symptoms. Women were a wide range of ages, from 17 to 91 years (mean 42.6 years) over a 20 month period. In addition to a standard urine culture, researchers performed quantitative polymerase chain reaction (qPCR) for two types of bacteria -- E. coli and Staphylococcus saprophyticus.

Overall, the authors isolated a uropathogen in 80.9% of urine cultures of symptomatic women. These were either primary pathogens like E. coli or S. saprophyticus or secondary pathogens such as Enterococcus spp. or other Gram-negative rods as defined by the European Guidelines for Urinalysis). Of these, E. coli was isolated in 83.2% of positive cultures.

There were 95.9% of symptomatic women who tested positive for E. coli via qPCR, while 90% of women in the control group tested negative for E. coli. The authors said that this indicated that "our findings in the symptomatic group are not caused by the detection of contamination due to the higher sensitivity of the qPCR."

They added that the rate of positive results in the control group "reflects the expected rate of asymptomatic bacteriuria ... in the general female population."

The authors concluded that "instead of spending time and energy to prove an uncomplicated UTI, physicians can rely on the typical symptoms and focus on acknowledging and managing the patient's complaints."

One in five women will have at least one urinary tract infection (UTI) in her lifetime, according to the National Kidney Foundation. And, if you’ve ever had a urinary tract infection, you are all too familiar with the burning urination and constant feeling of needing to go to the bathroom. But, did you know that some of the symptoms of a UTI are similar or the same as symptoms women experience when they have interstitial cystitis or painful bladder syndrome? How is a woman to know if it’s a UTI or painful bladder syndrome?

What is a Urinary Tract Infection (UT)?

A UTI is an infection of the urinary tract, most commonly affecting the bladder and the urethra (the tube that carries urine from the bladder to the outside of the body). When bacteria gets into the urethra and travels to the bladder, a UTI is often the result.  With a UTI, the bladder lining also becomes red, swollen and inflamed.

Common symptoms of a UTI include:

• Urinary urgency or the feeling that you need to urinate often. You may have to run to the bathroom several times per hour only to find you urinate only a few drops.
• A burning sensation when urinating.
• Abdominal pain, pelvic pressure and/or lower back pain. You may experience lower abdominal discomfort, bloating and/or feel pressure in the lower pelvic area, especially when urinating.
• Blood in the urine. Urine can appear to have a reddish or dark orange tiny, which signifies blood in the urine from the infection.
• Cloudy urine that has an odor
• Fever and/or chills

What is Interstitial Cystitis (IC)?

Interstitial cystitis (IC), also known as painful bladder syndrome, is another type of pelvic health condition that affects approximately eight million young and middle-aged women in the U.S. IC is a chronic inflammatory condition of the bladder lining that causes pain and pressure in the pelvic area around the bladder.

Symptoms of IC can be similar to the symptoms of a UTI:

• Pain in the bladder and in the pelvic region surrounding the bladder.
• Painful urination without the presence of bacteria or infection.
• Urgent and frequent need to urinate, even if the bladder is not full.

The Difference Between a UTI and IC

In women who have interstitial cystitis, urine culture results will be negative,  meaning that no bacteria are found in the urine as with a urinary tract infection. With IC, women may also experience pain during sexual intercourse, another symptom not commonly associated with a UTI.

Diagnosing & Treating a UTI Vs. Interstitial Cystitis

Typically, treatment for a UTI is a course of antibiotics, the use of over-the-counter medications to help relieve burning and/or bladder pain, and increasing the intake of water.

Some women, however, experience frequent UTIs that require more investigation. If recurrent UTIs are a problem, your doctor will perform a thorough pelvic exam to ensure nothing in the vagina or bladder is causing infection, and may also order diagnostic tests such as an ultrasound, CT scan, cystoscopy, or urine culture.

• Learn about other treatments for chronic UTIs here.

Diagnosing IC is often more difficult. What women often find frustrating about this condition is that no exact cause has been pinpointed; however many IC patients may also have other health conditions such as fibromyalgia, irritable bowel syndrome, endometriosis, and pelvic floor dysfunction. Your doctor will begin testing for other conditions that cause the same symptoms and come to a diagnosis of IC once other causes are ruled out.

Treating IC

While there is no cure for IC, treatments can provide relief from painful symptoms. Your doctor may provide several different therapies that have been shown to alleviate and/or diminish many of the symptoms of IC including:

• Physical therapy provided by a specialized pelvic health physical therapist with training in IC has been shown to be successful at improving symptoms in many women.
• Dietary changes such as avoiding bladder irritants or foods that may cause the bladder to flare or trigger symptoms, as well as adequate hydration.
• Bladder instillations
• Medications to relieve symptoms of IC
• Bladder distention

Learn more about treatment options for interstitial cystitis here.

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