Urinary Tract Infection: Diagnosis
Diagnosing UTI's in Women

UTI Guide

Urinary Tract Infection: Diagnosis


How Are Urinary Tract Infection's Diagnosed?
Doctor Diagnosis
Other Tests

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Guide To UTIs

How Are Urinary Tract Infection's Diagnosed?

Generally there are two types of urinary tract infections: upper tract infections (kidney infections) and lower tract infections (known as cystitis or bladder infections). The vast majority of cases of painful urination complaints (dysuria) turn out to be lower urinary tract infections. Many women never seek a diagnosis, particularly in instances where symptoms clear on their own within 24 hours. Other women, who may have had previous UTI episodes, self-treat with over the counter medications. If UTI symptoms persist, it will require a doctor's diagnosis and possible antibiotic treatment (see urinary tract infections treatment).

Doctor Diagnosis

Urinalysis (Urine Dipstick)

This test usually provides enough information for a doctor to prescribe treatment. The patient is asked for a urine sample which is then tested by the doctor using a dipstick for the presence of white blood cells (an indication of the presence of an infection). The patient will be asked for a mid-stream or clean-catch sample of their urine. To do this, the patient must:

1. Wash their hands. Then wash the vagina area four times from front to back, using clean soapy sponge each time.
2. Begin urinating into the toilet and stop when the bladder feels about half emptied.
3. Position the container provided by the doctor underneath the vagina to catch the next flow of urine.
4. When the container is two thirds full the remainder of the urine can flow into the toilet boil.
5. Place the cap onto the container without touching the inside of the rim. Ideally the sample will be taken in the doctor’s surgery. If the sample cannot be analyzed by the doctor within 2 hours of collection it must be refrigerated. Urine samples should not be sent by post.

Urine Culture

If the urinalysis tests positive for white blood cells a urine culture may ordered next. However, in many cases a doctor prescribes antibiotics based on the urinalysis alone. If the infection does not clear or recurs, a urine culture may be ordered. A urine culture involves incubating and growing the bacteria present in the urine so that it can be identified. The test may also be ordered if the urinalysis does not show signs of infection but the doctor still suspects a UTI is causing the symptoms. It may also be ordered if the doctor suspects a kidney infection. Pregnant women, even where is there no cause to suspect a UTI may be screened for bacteria with this test to avoid any possible pregnancy problems.


Typically the test result is considered positive where a single type of bacteria is present and growing at a high colony count. A culture which reports no growth within a 24 to 48 hour period usually indicates there is no infection. If UTI symptoms persist another culture may be performed on a fresh sample to test for other microorganisms and other possible causes. For example, the presence of white blood cells and low numbers of microorganisms in the urine could indicate a condition known as acute urethral syndrome. Where the sample shows the growth of lots of different bacteria, then it is likely that the growth is due to contamination and the test is void and will need to be repeated. If an infection is present, the doctor will be able to prescribe a suitable antibiotic based on the exact type of bacteria present.

Other Tests

If symptoms persist, the doctor may order other tests to check for any underlying conditions. Traditionally women with persistent recurrent UTI were perhaps over investigated leading to unnecessary expense and invasive procedures. As studies now show that 95 percent of all women with recurrent UTI have no abnormal structural issues, any further tests should be considered a last resort.

KUB Abdominal X-Ray
A kidney, ureter and bladder (KUB) x-ray is sometimes ordered for women with recurrent urinary tract infections. It is used to screen for structural abnormalities, to see if
anything is stopping the bladder from completely emptying or if there is narrowing of the urethral. It may also be used to check for signs and symptoms of kidney stones. Given the dangers to a fetus, x-rays should not be performed on pregnant women.

Ultrasound Scan
Ultrasound scans are less invasive than imaging tests and can be used to screen for any obstructions in the flow of urine (hydroephrosis).

Ruling Out Other Conditions

UTI symptoms can be caused by other conditions which should be considered by a doctor. These include:

Vaginitis, also known as vulvovaginitis effects women of all ages and is very common. It is an inflammation of the vagina which causes burning and itching.
It is usually caused by a fungus called candidiasis but may also be caused by bacteria or parasites. Occasionally the infection mimics a UTI causing painful and frequent urination.

Sexually Transmitted Diseases
Some STDs can cause painful urination. This may be considered where no bacteria growth is found in the urine culture. The most common types of STDs are chlamydia, gonorrhea and genital herpes.

Interstitial Cystitis
Interstitial cystitis (IC) is not considered a UTI (image). It is an inflammation of the bladder wall which can cause symptoms very similar to cystitis. As it is not caused by bacteria, no bacteria will be present in a urine culture. Painful intercourse is a common complaint and symptoms tend to worsen during times of stress.

Kidney Stones
Kidney stones can cause pain and blood in the urine, very similar symptoms to a kidney infection. No bacteria will be present with kidney stones.

Thinning of Vaginal Walls
After menopause, the vaginal walls can become very dry and delicate, causing painful urination similar to UTI. See vaginal dryness, also called vaginal atrophy.

  Related Articles on UTIs

For more related topics, see the following:

Douching: How douching works, different methods.
Urinary tract infections in older women.
Books on urinary tract infections: Self-help guides.

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