What are the symptoms of a Urinary Tract Infection (UTI)?

Symptoms of Urinary Tract Infection (UTI)

The primary symptoms of urinary tract infection include dysuria (painful urination), increased urinary frequency, urgency, hematuria, and suprapubic pain, with systemic symptoms like fever and flank pain indicating possible upper tract involvement. 1

Lower Urinary Tract Symptoms (Cystitis)

• Dysuria (painful urination) - a central symptom with over 90% accuracy in young women when not accompanied by vaginal symptoms 1
• Increased urinary frequency - needing to urinate more often than usual 1
• Urinary urgency - sudden, intense need to urinate 1
• Suprapubic pain/discomfort in the lower abdomen 1
• Changes in urine characteristics:
  • Cloudy urine 1
  • Change in urine color 1
  • Strong or foul-smelling urine 1
  • Visible blood in urine (macroscopic hematuria) 1

Upper Urinary Tract Symptoms (Pyelonephritis)

• Systemic symptoms that typically accompany lower urinary tract symptoms:
  • High fever 2, 1
  • Malaise 2
  • Vomiting 2
  • Flank pain or back pain 1
  • Costovertebral angle tenderness 1
• Pyelonephritis can lead to renal scarring, which is the most severe long-term sequela of UTI 2

Atypical Presentations in Older Adults

• Mental status changes, including new onset confusion or delirium 1
• Functional decline, including decreased mobility 1
• Behavioral changes, such as agitation or worsening aggression 1
• General symptoms:
  • New or worsening fatigue 1
  • Weakness 1
  • Malaise 1
  • Dizziness 1
• Gastrointestinal symptoms:
  • Decreased fluid or dietary intake 1
  • Nausea with or without vomiting 1

Presentations in Children

• In children, especially neonates and young infants, presentation may be nonspecific 2
• Symptoms can be similar to neonatal sepsis 2
• Not all children will present with fever 2
• Concomitant bacteremia is common with UTI in young children (4% to 36.4%) 2

Important Clinical Distinctions

• Cystitis (lower UTI) typically presents with localized symptoms (frequency, urgency, dysuria) 2
• Pyelonephritis (upper UTI) typically presents with systemic symptoms (high fever, malaise, vomiting, flank pain) 2
• Asymptomatic bacteriuria is common in certain age groups and should not be confused with symptomatic UTI 3
• Catheter-associated UTI may present with new onset or worsening of fever, altered mental status, malaise, lethargy, flank pain, or pelvic discomfort 2

Risk Factors for UTI

• Female gender (women have >50% lifetime risk) 1
• Sexual activity, especially with use of diaphragms and/or spermicides 1
• Postmenopausal status, particularly with urinary incontinence or cystocele 1
• Anatomical abnormalities 1
• Catheterization, especially indwelling catheters 1
• Diabetes and immunosuppression 1

Diagnostic Considerations

• UTIs are often diagnosed clinically based on symptoms 3
• Urine culture remains the gold standard for diagnosis 3
• In symptomatic women, bacterial growth as low as 10² colony-forming units/mL could reflect infection 3

Understanding these symptoms helps in early recognition and appropriate management of UTIs, potentially preventing complications such as pyelonephritis, renal scarring, and sepsis.