Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- dysuria
- urgency
- frequency
- suprapubic pain
- prior history of urinary tract infections (UTIs) and treatment history
Other diagnostic factors
- recent urinary tract instrumentation
- flank pain
- abdominal pain
- fever
- vaginal discharge
- vaginal pruritus
- dyspareunia
- structurally or functionally abnormal bladder
Risk factors
- frequent sexual intercourse
- history of UTI
- anatomical or functional abnormalities within the urinary tract
- spermicidal jelly
- urinary catheter
- asymptomatic bacteriuria during pregnancy or prior to urological surgery
- diabetes
- spinal cord injuries
- pregnancy
- immunosuppression
- older age
- lack of circumcision
- age <15 years for first UTI
- new sex partner in past year
- UTI history in mother
- diaphragm use
- obesity
- vaginal atrophy
- low socioeconomic status
Diagnostic investigations
1st investigations to order
- urinalysis
- urine microscopy
- urine culture with sensitivity
Investigations to consider
- pregnancy test
Treatment algorithm
uncomplicated urinary tract infection (UTI): non-pregnant
complicated UTI: non-pregnant
uncomplicated or complicated UTI: pregnant
at risk of chronic recurrent UTI
Contributors
Authors
Christopher Chapple, BSc, MD, FRCS (Urol), FEBU
Honorary Senior Lecturer of Urology
University of Sheffield
Consultant Urological Surgeon
Department of Urology
Royal Hallamshire Hospital
Sheffield
UK
Disclosures
CC is a consultant for MUVON Therapeutics, Proverum (on safety committee), Symimetic (non-financial), and Urovant Sciences. He is an author for Astellas and Ferring. He is a speaker for Allergan.
Altaf Mangera, MBChB (Hons), MD, FRCS (Urol), FEBU
Consultant Urologist
Department of Urology
Royal Hallamshire Hospital
Sheffield
UK
Disclosures
AM declares that he has no competing interests.
Acknowledgements
Dr Christopher Chapple and Dr Altaf Mangera would like to gratefully acknowledge Dr Michael K. Park, a previous contributor to this topic.
Disclosures
MKP declares that he has no competing interests.
Peer reviewers
James Malone-Lee, MD, FRCP
Professor of Medicine
Department of Clinical Physiology
Division of Medicine
Whittington Campus
University College London Medical School
London
UK
Disclosures
JML declares that he has no competing interests.
David Chelmow, MD
Chair
Department of Obstetrics and Gynecology
Virginia Commonwealth University
Richmond
VA
Disclosures
DC declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
European Association of Urology. Guidelines on urological infections. 2023 [internet publication].Full text
American Urological Association. Recurrent uncomplicated urinary tract infections in women: AUA/CUA/SUFU guideline. 2022 [internet publication].Full text
Nicolle LE, Gupta K, Bradley SF, et al. Clinical practice guideline for the management of asymptomatic bacteriuria: 2019 update by the Infectious Diseases Society of America. Clin Infect Dis. 2019 May 15;68(10):e83-110.Full text
National Institute for Health and Care Excellence. Urinary tract infection (lower): antimicrobial prescribing (NG109). Oct 2018 [internet publication].Full text
National Institute for Health and Care Excellence. Urinary tract infection (recurrent): antimicrobial prescribing (NG112). Oct 2018 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Pyelonephritis
- Vaginitis
- Interstitial cystitis
More DifferentialsGuidelines
- Urinary tract infection (recurrent): antimicrobial prescribing
- Urinary tract infections in pregnant individuals
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