From the Guidelines
A negative urine dipstick test does not rule out a urinary tract infection (UTI) in patients with typical symptoms of uncomplicated cystitis, such as dysuria, frequency, and urgency. According to the European Association of Urology guidelines on urological infections, published in 2024 1, the diagnosis of uncomplicated cystitis can be made with a high probability based on a focused history of lower urinary tract symptoms and the absence of vaginal discharge.
Possible Causes of UTI Symptoms with Negative Urine Dipstick Test
- The infection may be caused by a pathogen that does not produce nitrites, such as Enterococcus or Staphylococcus
- The infection may be early, and bacterial counts may be low, resulting in a negative dipstick test
- The urine may not have been in the bladder long enough for nitrites to form
- The patient may have urethritis or interstitial cystitis, which can mimic UTI symptoms but will not show positive dipstick results
Diagnostic Approach
In patients presenting with typical symptoms of uncomplicated cystitis, urine analysis, including dipstick testing, leads to only a minimal increase in diagnostic accuracy 1. However, if the diagnosis is unclear, dipstick analysis can increase the likelihood of a diagnosis of uncomplicated cystitis. A urine culture is recommended in certain situations, such as suspected acute pyelonephritis, symptoms that do not resolve or recur within 4 weeks after completion of treatment, women who present with atypical symptoms, and pregnant women 1.
Treatment Approach
For females with mild to moderate symptoms, symptomatic therapy, such as ibuprofen, may be considered as an alternative to antimicrobial treatment 1. The choice of antimicrobial therapy should be guided by the spectrum and susceptibility patterns of the aetiological pathogens, efficacy for the particular indication in clinical studies, tolerability and adverse reactions, adverse ecological effects, and costs and/or availability 1.
From the Research
Possible Causes of Urinary Tract Infection (UTI) Symptoms with a Negative Urine Dipstick Test
The possible causes of UTI symptoms with a negative urine dipstick test can be attributed to several factors, including:
- False negative results from the dipstick test, which can occur due to various reasons such as low bacterial count, presence of certain types of bacteria, or interference from other substances in the urine 2
- Presence of antibiotic-resistant bacteria, which may not be detected by the dipstick test 3
- Inability of the dipstick test to detect certain types of UTIs, such as those caused by fungi or viruses 4
- Limitations of the dipstick test in detecting UTIs in certain patient populations, such as diabetic patients 5
Factors Associated with UTI Diagnosis
Several factors have been associated with UTI diagnosis, including:
- Typical UTI symptoms such as dysuria, change of urine appearance, suprapubic or flank pain, and increased urinary frequency 4
- Urinary dipstick analysis for white blood cells (WBCs), nitrite, and blood, which can indicate the presence of a UTI 4, 2
- Presence of infection stones or positive stone culture, which can increase the risk of UTI 6
Limitations of Urine Dipstick Tests
Urine dipstick tests have several limitations, including: