Urinary tract infection (UTI) in women is diagnosed using urine dipstick, microscopic urinalysis (bacteria, white blood cell, red blood cell), and/or urine culture.
Escherichia coli is the most common organism in uncomplicated infections.
Antibiotic selection should be guided by local bacterial susceptibilities and guidelines, or based on known urine culture and sensitivity.
Pyelonephritis is a common complication of lower UTI.
A UTI is an infection of the kidneys, bladder, or urethra. Infectious cystitis is the most common type of UTI, which is caused by a bacterial infection of the bladder. Pyelonephritis is an infection of the kidney that often occurs via bacterial ascent, and urethritis is an infection causing an inflammation of the urethra.
History and exam
Key diagnostic factors
- new nocturia
- cloudy-looking urine
- risk factors
Other diagnostic factors
- visible haematuria
- suprapubic pain or tenderness
- flank pain
- costo-vertebral angle tenderness
- new incontinence
- new or worsening delirium/debility
- loss of diabetic control
- sexual activity
- spermicide use
- positive family history of UTIs
- history of recurrent UTI
- presence of a foreign body
- insulin-treated diabetes
- high lifetime number of UTIs
- recent antibiotics
- poor bladder emptying
- increasing age
1st investigations to order
- urine dipstick
- urine culture and sensitivity
Investigations to consider
- urine microscopy
- post-void residual
- renal ultrasound
- abdominal/pelvic CT
no catheter in situ: age <65 years and non-pregnant
no catheter in situ: age ≥65 years
no catheter in situ: pregnant
catheter in situ
Andrew Lewington, BSc (Hons), MBBS, MEd, MD, FRCP
Consultant Renal Physician
Honorary Associate Professor
Leeds Teaching Hospitals NHS Trust
Head of MBChB
School of Medicine
University of Leeds
AL has been the principal applicant/co-applicant for a number of grants including: Engineering and Physical Sciences Research Council Research - Multiplexed AKI biomarker detection with a single molecule biosensor; Leeds Cares - A novel, non-invasive diagnostic approach to assess kidney transplant health through the targeted measurement of biomarkers of kidney injury and immune response in kidney transplant recipients at the Leeds Teaching Hospitals NHS Trust; Kidney Research Yorkshire - Use of enhanced technology to characterise haemodialysis treatment for acute kidney injury (AKI); Bringing It Home - Validation of a micro-sampling technique for measuring tacrolimus and creatinine remotely; and to fund a research nurse; British Renal Society - Renal function assessment with point of care creatinine in diverse populations (RAPID), and several NIHR grants including on a) Improving the quality of post-discharge care following AKI b) An investigation into the use of remote blood sample collection to reduce health inequalities in patients with mental health disorders c) A comparison of remote blood collection devices: a human factor use study d) Defining the characteristics for a novel automatic device to monitor urine output in catheterized patients e) Leeds Medtech and In-vitro Diagnostic Cooperative Grant Extension f) Surgical MedTech Co-operative for the 2019/20 proof-of-principle funding stream g) A pilot investigation into the use of beta-trace protein for residual renal function estimation in haemodialysis h) Application of functional MRI to improve assessment of chronic kidney disease (AFiRM study) i) SuperResPath-Renal: Quantitative super-resolution technology for a fast, decentralised clinical diagnosis of renal pathologies. AL is the co-author of a number of manuscripts including on extracorporeal treatments, AKI, kidney function testing prior to contrast-enhanced CT, plasma exchange and glucocorticoids in severe ANCA-associated vasculitis, COVID-19 rapid diagnostics, multimodal image-guided ablation on management of renal cancer in Von-Hippel-Lindau syndrome, and on a summary of NICE guidance on CKD. AL is the author of several book chapters on nephrology and AKI. AL has received expenses for accommodation and travel for conferences at which he has given lectures, other than those delivered virtually. AL was a member of the AKI Scientific Program Committee for the ISN World Congress of Nephrology 2020-2021 and Chair of this same committee in 2021-2022.
BMJ Best Practice would like to gratefully acknowledge the previous expert contributors, whose work has been retained in parts of the content:
Una J. Lee, MD
Female Pelvic Medicine and Reconstructive Surgery Section of Urology and Renal Transplantation
Virginia Mason Medical Center
UJL declares that she has no competing interests.
Consultant Urological Surgeon
Princess Royal Spinal Injuries Unit
Sheffield Teaching Hospitals NHS Foundation Trust
SR is lead for the spinal injuries urology course; in the past this course has received funding from Coloplast, AMS, and Hollister. SR is chair of the Female, Neurological, and Urodynamic Urology section of the British Association of Urological Surgeons.
Section Editor, BMJ Best Practice
Consultant in Paediatric Emergency Medicine
Royal London Hospital
TD declares that she has no competing interests.
Section Editor, BMJ Best Practice
EQ declares that she has no competing interests.
Lead Section Editor, BMJ Best Practice
SM works as a freelance medical journalist and editor, video editorial director and presenter, and communications trainer. In this capacity, she has been paid, and continues to be paid, by a wide range of organisations for providing these skills on a professional basis. These include: NHS organisations, including the National Institute for Health and Care Excellence, NHS Choices, NHS Kidney Care, and others; publishers and medical education companies, including the BMJ Group, the Lancet group, Medscape, and others; professional organisations, including the British Thoracic Oncology Group, the European Society for Medical Oncology, the National Confidential Enquiry into Patient Outcome and Death, and others; charities and patients’ organisations, including the Roy Castle Lung Cancer Foundation and others; pharmaceutical companies, including Bayer, Boehringer Ingelheim, Novartis, and others; and communications agencies, including Publicis, Red Healthcare and others. She has no stock options or shares in any pharmaceutical or healthcare companies; however, she invests in a personal pension, which may invest in these types of companies. She is managing director of Susan Mayor Limited, the company name under which she provides medical writing and communications services.
Lead Section Editor, BMJ Best Practice
RW declares that she has no competing interests.
Comorbidities Editor, BMJ Best Practice
JC declares that she has no competing interests.
Drug Editor, BMJ Best Practice
AM declares that he has no competing interests.
- Over-active bladder
- Urothelial carcinoma of the bladder or upper urinary tract
- Non-infectious urethritis
- Diagnosis of urinary tract infections. Quick reference tool for primary care: for consultation and local adaptation
- Urinary tract infection (lower): antimicrobial prescribing
CystitisMore Patient leaflets
- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer