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Uncomplicated UTI symptoms ‘almost always due to bacterial infection’

Almost all women presenting with typical symptoms of a urinary tract infection did have a bacterial infection, even when standard tests of their urine were negative, a study in Belgium found.

GP researchers found that although standard tests ruled out a bacterial infection in one fifth of the women, 98% of them tested positive using a DNA testing method.

The researchers said that their findings could mean that in future GPs can avoid doing dipstick or other tests and simply assume a bacterial infection.

In the study, the team carried out both a DNA test and standard mid-stream urine culture on urine samples from 220 women with any of the symptoms of dysuria, frequency or urgency, as well as from 86 women without these symptoms.

Among the women with the typical symptoms of an uncomplicated urinary tract infection (UTI), the standard testing detected E. coli or other bacterial pathogens in 81% of urine samples – whereas the DNA test found evidence of E. coli in 96% of samples and S. saphrophyticus in 9%.

In the samples from women without symptoms, the standard testing picked up E. coli in 11% and the DNA test in 12%.

The team concluded that on the basis of their findings ‘if non-pregnant women consult their GP with typical symptoms of an uncomplicated UTI and without vaginal irritation or arguments for a sexually transmitted infection, the diagnosis of a UTI can be accepted without further investigations and can be treated empirically’.

Lead author Dr Stefan Heytens, a practising GP and researcher at the department of family medicine and primary health care at the University of Ghent, told Pulse the findings showed that ‘in otherwise healthy women in primary care who are consulting with typical complaints of an uncomplicated UTI, no further testing is needed’.

He added: ‘This will makes things easier for GPs – no need to spend time and energy to gain more certainty about the diagnosis.’

Dr Heytens added that the research could not be used to conclude women should simply be given an antibiotic, however, but said it was important for GPs to be able to tell women they have an infection so as to acknowledge their concerns.

He said: ‘Research confirmed that it is most frustrating for women to be sent home with the message that they probably do not have an infection. They are worried and are left with many questions about their condition.’ 

Currently SIGN guidelines on management of UTI advise GPs to use a dipstick test in women whose symptoms are mild or there are two or more symptoms, but to consider antibiotic treatment in women with severe or three or more symptoms. NICE suggests that GPs can simply offer painkillers initially to women who want to see if their symptoms clear up on their own, but otherwise to offer antibiotics.

The study comes after MPs called on NICE to look at alternative testing approaches for UTI, particularly in women with recurrent infections, as current urine culture testing could be missing infections in half of women.