Diagnosing UTI: Tests and Screenings, Early Diagnosis, and Your Doctors
There is more than one way to diagnose a urinary tract infection (UTI). Knowing which test you need will help ensure you get the treatment you require quickly. When UTIs are treated properly in a timely fashion, they rarely lead to complications. However, UTIs can result in serious consequences, including kidney damage, if left undiagnosed and untreated. (1)
If you are experiencing symptoms like painful urination or a frequent urge to use the bathroom, you might be headed toward a UTI diagnosis. To find out for sure, you’ll need to have a healthcare professional, like your general practitioner, test your urine for both bacteria and other components that could indicate a urinary tract infection. When diagnosing a UTI, a urine test may be part of the standard protocol, but that is not always the case. In fact, fewer than 1 in 5 patients treated for a UTI actually has a laboratory urine test to diagnose their problem, according to a 2019 study. (2)
Because UTIs are usually detected using urine you’ve collected yourself (you’ll probably be sent to the restroom at your doctor’s office), it’s very important to use the proper technique called a “clean catch.” This helps to ensure that your urine sample is not contaminated with bacteria from the vagina or the tip of the penis. First, wash your hands thoroughly with warm soapy water. Next, clean your genital area with a special antiseptic wipe that the nurse has given to you. When you begin to urinate, allow your first few drops to go into the toilet, which helps to wash out your urethra. Then, midstream, carefully urinate into a small, sterile plastic jar or similar container. (Rarely, a catheter may be used to collect urine. This is more common in young children and older adults.) Urine-based testing includes:
This UTI test is also called urinalysis, which includes three things: a visual exam of your urine, an under-the-microscope examination, and a chemical assessment. Your healthcare provider will first check the color and clarity of your urine specimen. (A UTI may cause the urine to appear cloudy and/or reddish or cola colored.) For the microscopic exam, your urine will be analyzed for the presence of substances that normally don’t belong in urine, such as bacteria, red blood cells, white blood cells, and crystals (these form from chemicals in the urine). Finally, a dipstick test is used to examine the chemistry of your urine. Here, a thin plastic stick containing chemicals is placed into your urine to detect abnormalities, such as elevated pH levels, the presence of nitrites, leukocyte esterase (an enzyme found in certain white blood cells), and more. The strip changes color if a substance is present at any level that’s above normal. (3) Results for these tests are available quickly, making urinalysis the preferred first step in diagnosing UTIs. However, urinalysis alone usually doesn’t provide a definitive UTI diagnosis. (4)
Urinalysis is sometimes followed by a urine culture. With this test, the specific bacteria and yeasts causing the infection can be detected. If a urine culture is positive, your healthcare provider might do susceptibility testing, which helps determine which antibiotics will be most effective. This is considered the gold standard for diagnosing a UTI, but it’s expensive and requires at least 48 hours to produce results. (5)
If you’ve experienced three or more UTIs within 12 months, or two or more occurrences within six months, your healthcare provider may order imaging tests along with urine tests. (6) These tests may include:
Here, a device called a transducer is placed on your abdomen, which transmits sound waves. Those waves create images of your kidneys and bladder so your healthcare provider can examine them for irregularities. This is an outpatient procedure, and no anesthesia is required.
For this test, you’ll need to lie down on a table that slides into a tunnel-like device where a series of X-rays will be taken in order to examine three-dimensional images of your urinary tract. This is another outpatient procedure that requires no anesthesia.
You’ll likely lie on a table that slides into a tunnel where radio waves and magnets are used to take a sequence of images of your urinary tract from different angles. This is another outpatient test that requires no anesthesia.
For this test, also called cystourethroscopy, a long, thin tube fitted with a lens is inserted into the urethra and passed through to the bladder, allowing your healthcare provider a view inside your bladder. This is often performed in a doctor’s office using a local anesthetic. (7)
Pregnant women are especially susceptible to urinary tract infections, thanks in part to pregnancy hormones, so it’s recommended that all get screened for UTIs between 12 and 16 weeks of pregnancy or at one’s initial prenatal appointment. For this population, a urine culture is considered the most reliable test, especially for asymptomatic bacteriuria (ASB), which is a UTI without symptoms. (ASB occurs in 2 to 7 percent of pregnant women.) (8) However, since there’s a high rate of false positives for pregnant women, a positive result often leads to a second test a week later in order to avoid unnecessary treatment. (9)
A UTI diagnosis in a child requires both a urinalysis and a urine culture, according to the most recent clinical practice guidelines by the American Academy of Pediatrics. (10) In order to gather a proper urinary sample from a very young child, catheterization or a suprapubic aspirate (inserting a needle into the bladder just above the pubic bone) is often recommended. Alternatively, your healthcare provider may simply leave the child diaper-free in order to obtain a sample when the child urinates. Some physicians collect urine using a bag. Samples obtained in this way, however, have a high rate of contamination, making results unreliable.
For children who are potty trained, a midstream urine sample should be collected. It’s often recommended that girls sit backward on the toilet, in order to widen the labia and prevent contamination. (11)
While an over-the-counter UTI test is not the preferred means of UTI diagnosis, this type of testing is often turned to by those with recurrent infections. It’s important to note that a negative home dipstick test — along with a strong history of UTI — cannot reliably rule out a urinary tract infection, according to a study from 2015. Researchers did note, however, that at-home testing may be useful to some as a first-level screener before they get tested by a physician. Because OTC UTI tests miss some infections, it’s important that you contact a healthcare professional if your results come back negative, yet symptoms persist. (12)
There are several over-the-counter UTI dipstick tests available, and they work much like you’d expect: You’re instructed to offer a clean-catch urine sample by holding the provided test strip in your urine stream for a few seconds. (For some kits, you may be able to collect urine in a sterile cup and simply dip the strip into your urine sample.) After a short wait, the color of the test strip changes to indicate the presence of a possible infection. To ensure the most accurate reading possible, use the test right after you wake up, with urine that’s been in your bladder overnight.
While some OTC UTI tests screen for just nitrites (bacteria have an enzyme that converts nitrates into nitrites), other tests analyze leukocytes (white blood cells) as well. And still others add a pH-level screener, too. This means that for many UTI tests, you will need to look at more than one test pad on a single strip — and those results appear at varying times. For instance, your nitrite results may appear a full minute before leukocytes show. Once all results are in, you’ll need to closely compare the test pads with corresponding color blocks that appear on an included chart. You might notice, for example, that the nitrites box went from white to pink. That means nitrites have been detected, which suggests that you may have a UTI. (13)
There is not simply one type of UTI doctor. Instead, your family doctor, your gynecologist, a nurse practitioner, or a provider at your local urgent care can all treat most urinary tract infections. However, if you’ve repeatedly experienced UTIs in the past or have a chronic kidney infection, your healthcare provider may refer you to a urologist, a physician who specializes in urinary tract conditions, or a nephrologist, a physician who specializes in kidney disorders. (14)
RELATED: Surprising Risk Factors for UTIs
While urinalysis is useful, it is not always definitive in terms of diagnosis of a UTI. False-negative results can and do occur. False-negative cultures can appear for a variety of reasons, including mishandling of the urine specimen and a urine sample that is too diluted. However, many women who experience typical UTI symptoms and receive a negative urine culture actually do have a UTI and should discuss antibiotic treatment with their healthcare provider. (15)
At the same time, women with symptoms of a UTI but whose tests don’t show any infection may have:
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