Symptoms of Urinary Tract Infection (UTI)
The primary symptoms of a urinary tract infection (UTI) include dysuria (painful urination), increased urinary frequency and urgency, hematuria, and new or worsening incontinence, with dysuria being the central symptom in diagnosis with over 90% accuracy in young women. 1
Common UTI Symptoms
Lower Urinary Tract Symptoms (Cystitis)
- Dysuria (painful or burning sensation during urination)
- Increased urinary frequency
- Increased urinary urgency
- Hematuria (blood in urine)
- New or worsening urinary incontinence
- Suprapubic pain or discomfort
- Nocturia (frequent urination at night)
Upper Urinary Tract Symptoms (Pyelonephritis)
When infection spreads to the kidneys, additional symptoms may include:
- High fever
- Flank pain or tenderness
- Malaise
- Vomiting
- Abdominal pain
Symptom Presentation by Population
Women
- Dysuria without vaginal discharge is highly specific for UTI
- Acute-onset dysuria has >90% accuracy for UTI in young women 1
- Women experience UTIs more frequently (affecting approximately 8% by age 7) 1
Men
- May present with similar symptoms to women
- Often have more complicated infections
- May have symptoms of prostatitis (perineal pain, ejaculatory pain)
Children
- Symptoms may be nonspecific, especially in infants
- May present with fever, irritability, poor feeding
- Older children may report abdominal pain, frequency, and dysuria 1
Elderly
- May present with atypical symptoms
- Confusion or altered mental status
- Incontinence (new or worsening)
- Symptoms may be less clear in older adults 1
Diagnostic Considerations
Acute-onset dysuria is the most specific symptom for UTI diagnosis, particularly when not accompanied by vaginal irritation or discharge 1. The presence of symptoms is the key factor that distinguishes a UTI requiring treatment from asymptomatic bacteriuria 2.
For symptomatic relief of UTI discomfort, phenazopyridine can be used to relieve pain, burning, urgency, and frequency while awaiting antibiotic effectiveness, but should not delay definitive diagnosis and treatment of the underlying infection 3.
Important Clinical Pearls
- Dysuria is the central symptom in UTI diagnosis 1
- Symptoms alone may be sufficient for diagnosis in women with typical presentation 4
- Absence of fever does not exclude development of pyelonephritis 1
- UTI symptoms without bacteriuria may indicate other conditions like urethritis or interstitial cystitis
- Symptoms should guide treatment decisions, even with low bacterial counts in urine culture 2
When to Suspect Complicated UTI
Consider a complicated UTI when symptoms are accompanied by:
- Fever >38°C
- Flank pain
- Symptoms lasting >7 days
- Recent urinary tract instrumentation
- Immunosuppression
- Pregnancy
- Male gender
- Anatomical abnormalities of the urinary tract 1
Early recognition of UTI symptoms and prompt treatment can prevent progression to more serious infections like pyelonephritis and urosepsis, which can lead to significant morbidity and mortality.