Urinary tract infections (UTIs) are among the world’s most prolific infections. According to the Urology Care Foundation, UTIs cause more than 8.1 million visits to health care providers each year and about 60% of women and 12% of men will have at least one UTI during their lifetime.

A UTI occurs when bacteria gets into your urine and travels up to your bladder. Given how common it seems to be, there are increasing concerns that our current testing processes are inadequate and outdated.

The current approach to diagnosing UTIs is the utilisation of dipstick testing. Dipstick testing helps detect nitrites, chemicals created by the presence of gram-negative bacteria in the urine; leukocytes, which are white blood cells produced to fight infection; and red blood cells. However, studies have shown that a negative dipstick test in the presence of a strongly suggestive history of UTI cannot reliably rule out an infection.

Some findings imply that a large proportion of women who seek medical help for UTIs such as cystitis are being misdiagnosed, with some being told their problem is psychological. Many women with severe symptoms are also likely to have been refused antibiotics.

In addition, there are also doubts concerning another diagnostic test — mid-stream urine culture — that is usually reserved for complicated infections or suspected UTIs in men. Urology experts say that there is a “recognised weakness” in conventional urine culture testing, owing to the fact that the threshold for determining the presence of a UTI is based on outdated research from the 1950s.

This means that patients who test negative on the dipstick test may well be suffering from a UTI after all. But because they have tested negative, such patients may remain undiagnosed and untreated.

Urine culture testing is based on work carried out in 1957 by the scientist Edward Kass, who gathered urine samples from a small group of pregnant women who had pyelonephritis, meaning his work was not representative of patients with acute cystitis.

There is now consensus that dipsticks are unreliable in adults aged over 65 years, so they are not generally recommended for these patients. But advice varies for those aged under 65 years with no risk factors for complicated infection.

Perhaps the best way to look at the dipstick test is to use it as a means of increased accuracy, as opposed to it being the absolute barometer of the presence of a UTI. In other words, patients should still be diagnosed on the basis of signs and symptoms with the dipstick test added on to prevent the use of unnecessary antibiotics.

Symptoms of UTI may include:

  • A strong, persistent urge to urinate
  • A burning sensation when urinating
  • Passing frequent, small amounts of urine
  • Urine that appears cloudy
  • Urine that appears red, bright pink or cola-colored — a sign of blood in the urine
  • Strong-smelling urine
  • Pelvic pain, in women — especially in the center of the pelvis and around the area of the pubic bone

So if you have the above symptoms, you might well have a UTI even if the dipstick test proves inconclusive.

*This article does not replace professional medical advice.

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