Urinary tract infections in women

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 2 Apr 2025

Last updated: 27 Feb 2025

Urinary tract infections in women can be clinically categorized into uncomplicated/complicated, acute, or recurrent.

Escherichia coli is the most common organism in uncomplicated infections.

Costovertebral angle tenderness together with fever suggests pyelonephritis.

Diagnosed using urine dipstick, microscopic urinalysis (bacteria, white blood cell, red blood cell), and urine culture.

Antibiotic selection should be guided by local bacterial susceptibilities and guidelines, or based on known urine culture and sensitivity.

Definition

A urinary tract infection (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

dysuria
urinary frequency
hematuria
back/flank pain
costovertebral angle tenderness
fever

Full details

Other diagnostic factors

urinary urgency
suprapubic pain and tenderness

Full details

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

Full details

Diagnostic tests

1st tests to order

urine dipstick
urine microscopy
urine culture and sensitivity

Full details

Tests to consider

postvoid residual (PVR)
renal ultrasound
abdominal/pelvic CT scan
cystoscopy

Full details

Treatment algorithm

ACUTE

uncomplicated

complicated suitable for outpatient therapy: not pregnant

complicated suitable for outpatient therapy: pregnant

complicated requiring inpatient therapy: not pregnant

complicated requiring inpatient therapy: pregnant

ONGOING

uncomplicated recurrent (3 or more in 12 months): related to sexual intercourse

uncomplicated recurrent (3 or more in 12 months): unrelated to sexual intercourse

Contributors

Authors

Una J. Lee, MD

Female Pelvic Medicine and Reconstructive Surgery

Section of Urology and Renal Transplantation

Virginia Mason Medical Center

Seattle

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 monograph, 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

Priyanka Sharma, MD

Associate Staff

Cleveland Clinic Foundation

Cleveland

Disclosures

PS declares that she has no competing interests.

Timothy J. Benton, MD

Associate Residency Director

Texas Tech University Health Sciences Center

Amarillo

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

Disclosures

PL declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

European Association of Urology. EAU guidelines on urological infections. Apr 2024 [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 Mar 21.Full text Abstract

Bent S, Nallamothu BK, Simel DL, et al. Does this woman have an acute uncomplicated urinary tract infection? JAMA. 2002 May 22-29;287(20):2701-10. Abstract

The 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 Differentials
Guidelines
- Guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2024 update
- Guidelines on urological infections
More Guidelines
Patient information
Cystitis
More Patient information
Log in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer

Urinary tract infections in women

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic tests

1st tests to order

Tests to consider

Treatment algorithm

uncomplicated

complicated suitable for outpatient therapy: not pregnant

complicated suitable for outpatient therapy: pregnant

complicated requiring inpatient therapy: not pregnant

complicated requiring inpatient therapy: pregnant

uncomplicated recurrent (3 or more in 12 months): related to sexual intercourse

uncomplicated recurrent (3 or more in 12 months): unrelated to sexual intercourse

Contributors

Authors

Una J. Lee, MD

Disclosures

Acknowledgements

Disclosures

Peer reviewers

Priyanka Sharma, MD

Disclosures

Timothy J. Benton, MD

Disclosures

Paul Little, BA (Oxon), MBBS, MRCP, MSc, FRCGP, MD

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Patient information

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice