Urinary tract infections in women
Summary
Definition
History and exam
Key diagnostic factors
- dysuria
- urinary frequency
- hematuria
- back/flank pain
- costovertebral angle tenderness
- fever
Other diagnostic factors
- urinary urgency
- suprapubic pain and tenderness
Risk factors
- sexual activity
- spermicide use
- postmenopause
- positive family history of UTIs
- history of recurrent UTI
- presence of a foreign body
- insulin-treated diabetes
- high lifetime number of UTIs
- recent antibiotic use
- poor bladder emptying
- increasing age
Diagnostic tests
1st tests to order
- urine dipstick
- urine microscopy
- urine culture and sensitivity
Tests to consider
- postvoid residual (PVR)
- renal ultrasound
- abdominal/pelvic CT scan
- cystoscopy
Treatment algorithm
confined to bladder without complicating factors
complicating factors present (nonpregnant): suitable for outpatient therapy
pregnant: suitable for outpatient therapy
complicating factors present (nonpregnant): requiring inpatient therapy
pregnant: requiring inpatient therapy
recurrent confined to bladder (3 or more in 12 months): related to sexual intercourse
recurrent confined to bladder (3 or more in 12 months): unrelated to sexual intercourse
Contributors
Expert advisers
Una J. Lee, MD
Female Pelvic Medicine and Reconstructive Surgery
Section of Urology and Renal Transplantation
Virginia Mason Medical Center
Seattle
WA
Disclosures
UJL declares that she has no competing interests.
Acknowledgements
Dr Una J. Lee would like to gratefully acknowledge Dr Elliot Blau for his contribution to this topic, and Dr Bhavin N. Patel and Dr Howard B. Goldman, previous contributors to this topic.
Disclosures
EB, BNP, and HBG declare that they have no competing interests.
Peer reviewers
Bernard G. Jaar, MD, MPH
Clinical Director
Johns Hopkins School of Medicine
Division of Nephrology
Baltimore
MD
Disclosures
BGJ declares that he has no competing interests.
Timothy J. Benton, MD
Associate Residency Director
Texas Tech University Health Sciences Center
Amarillo
TX
Disclosures
TJB declares that he has no competing interests.
Paul Little, BA (Oxon), MBBS, MRCP, MSc, FRCGP, MD
Professor of Primary Care Research
Community Clinical Sciences Division
University of Southampton
Southampton
UK
Disclosures
PL 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
Trautner BW, Cortes-Penfield NW, Gupta K, et al. IDSA 2025 guideline update on complicated urinary tract infections. Jul 2025 [internet publication].Full text
European Association of Urology. EAU guidelines on urological infections. Mar 2025 [internet publication].Full text
American College of Obstetricians and Gynecologists. Urinary tract infections in pregnant individuals. Obstet Gynecol. 2023 Aug 1;142(2):435-45.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Asymptomatic bacteriuria
- Pyelonephritis
- Urinary tract stones
More DifferentialsGuidelines
- EAU guidelines on urological infections
- IDSA 2025 guideline update on complicated urinary tract infections
More GuidelinesPatient information
Cystitis
More Patient information
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