Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Diagnosis of urinary tract infection (UTI) in adults:
- In women under 65 years, consider UTI if one or more key symptoms such as dysuria, new nocturia, or cloudy urine are present, or other urinary symptoms like frequency, urgency, suprapubic pain or tenderness, or haematuria. In women over 65 or with catheter use, isolated new-onset dysuria or two or more urinary or non-specific symptoms should prompt consideration of UTI NICE CKS.
- Assessment includes history (symptom onset, severity, evolution, sexual history, risk factors for recurrent/complicated UTI, family history, pregnancy possibility, contraception, treatments), physical exam (vital signs, abdominal and possibly vulval/pelvic examination), pregnancy test, and urine dipstick and/or culture depending on presentation and risk NICE CKS.
- In men under 65, consider other genitourinary causes and sexual history for STIs (e.g., chlamydia, gonorrhoea). In men 65 and older, exclude other causes and check for sepsis or pyelonephritis. Confirm diagnosis in men with urine culture before empirical treatment. Do not rely on dipstick testing alone in men, as it is unreliable, especially over age 65 NICE CKS.
Management of urinary tract infection in adults:
- For women, manage according to symptom severity and risk factors. Consider immediate or delayed antibiotic treatment if acute uncomplicated UTI is suspected, using previous culture and antibiotic history to guide prescribing NICE CKS.
- Women with catheter-associated UTI should have the catheter ideally removed or replaced before starting antibiotics NICE CKS.
- Advise on self-care for symptom relief and provide information on when to seek urgent medical review if symptoms worsen or do not improve NICE CKS.
- Urgent hospital admission is needed if there is suspected serious or life-threatening complication or inability to tolerate or adhere to primary care management NICE CKS.
- For men, confirm infection by urine culture and sensitivity before starting empirical antibiotics NICE CKS. Evaluate for alternative causes, sepsis, pyelonephritis, prostatitis as necessary NICE CKS.