Urinary tract infections in women

Last reviewed: 18 Jul 2022
Last updated: 01 Dec 2021



History and exam

Key diagnostic factors

  • dysuria
  • new nocturia
  • cloudy-looking urine
  • risk factors
  • fever
Full details

Other diagnostic factors

  • urgency
  • visible haematuria
  • frequency
  • suprapubic pain or tenderness
  • flank pain
  • costo-vertebral angle tenderness
  • new incontinence
  • new or worsening delirium/debility
  • loss of diabetic control
  • malaise
  • rigors
Full details

Risk factors

  • sexual activity
  • spermicide use
  • post-menopause
  • 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
Full details

Diagnostic investigations

1st investigations to order

  • urine dipstick
  • urine culture and sensitivity
Full details

Investigations to consider

  • urine microscopy
  • post-void residual
  • renal ultrasound
  • abdominal/pelvic CT
Full details

Treatment algorithm


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


Expert advisers

Andrew Lewington,

Consultant Renal Physician

Honorary Associate Professor

Nephrology Department

Leeds Teaching Hospitals NHS Trust




AL is Associate Clinical Director of NIHR Leeds In-Vitro Diagnostics Co-operative, Co-Chair of UK Kidney Research Consortium Renal Clinical Study Group, Member of Kidney Research UK Research Grant Committee, Committee Member of NICE Kidney Injury Clinical Guideline Update 2018-20, Committee Member of NICE Diagnostic Assessment for Point of Care Creatinine Testing 2018-19. AL attended the Acute Dialysis Quality Initiative Meeting in San Diego 2018 (accommodation expenses); AL was a speaker at the AKI & CRRT Conference in San Diego 2019 (travel and accommodation expenses), the AKI Conference in Coventry 2019 (travel expenses), and the NIHR AKI and Sepsis Meeting in Leeds 2019 (no expenses).


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.

Peer reviewers

Sheilagh Reid,

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.


Tessa Davis,

Section Editor, BMJ Best Practice

Consultant in Paediatric Emergency Medicine

Royal London Hospital




TD declares that she has no competing interests.

Emma Quigley,

Section Editor, BMJ Best Practice


EQ declares that she has no competing interests.

Susan Mayor,

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.

Rachel Wheeler,

Lead Section Editor, BMJ Best Practice


RW declares that she has no competing interests.

Julie Costello,

Comorbidities Editor, BMJ Best Practice


JC declares that she has no competing interests.

Adam Mitchell,

Drug Editor, BMJ Best Practice


AM declares that he has no competing interests.

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