Symptoms of UTI in Females
The hallmark symptom of UTI in women is acute-onset dysuria (painful urination), which has over 90% accuracy for diagnosing UTI when not accompanied by vaginal irritation or discharge. 1
Core Urinary Symptoms
The primary symptoms that indicate a UTI include:
- Dysuria is the central diagnostic symptom and should be present for UTI diagnosis 1, 2
- Increased urinary frequency - needing to urinate more often than usual 1, 2
- Urinary urgency - sudden, intense need to urinate 1, 2
- Hematuria - blood in the urine, which may be visible or microscopic 1, 2
- New or worsening urinary incontinence - loss of bladder control 1, 2
- Suprapubic pain - discomfort or tenderness in the lower abdomen 2
Additional Urinary Signs
- Cloudy urine or changes in urine color 2
- Change in urine odor 2
- Macroscopic hematuria - visible blood in urine 2
Upper Tract Infection Symptoms (Pyelonephritis)
If the infection ascends to the kidneys, additional systemic symptoms appear:
- Fever (>38°C) 1, 2
- Flank pain or back pain 1, 2
- Costovertebral angle tenderness 1, 2
- Chills 1
- Nausea and vomiting 1, 2
Special Considerations for Older Women
In postmenopausal and elderly women, UTI symptoms may be less clear and present atypically. 1 These patients may exhibit:
- Mental status changes - new onset confusion or delirium 2
- Functional decline - decreased mobility or ability to perform daily activities 2
- Behavioral changes - agitation or worsening aggression 2
- General symptoms - new or worsening fatigue, weakness, malaise, dizziness 2
- Gastrointestinal symptoms - decreased appetite, nausea, vomiting 2
Diagnostic Approach
When evaluating for UTI, dysuria must be present in conjunction with variable degrees of the other urinary symptoms. 1 The diagnosis should be confirmed with:
- Urinalysis including assessment of white blood cells, red blood cells, and nitrites 1
- Urine culture with >10² colony-forming units/mL in symptomatic patients is the diagnostic standard 3
- Culture should be obtained before initiating treatment in patients with recurrent UTIs 1, 4
Important Clinical Pitfalls
- Acute-onset symptoms are key - chronic or long-standing urinary symptoms are less likely to represent acute UTI 1
- Vaginal symptoms suggest alternative diagnosis - if dysuria is accompanied by vaginal irritation or increased vaginal discharge, consider vaginitis rather than UTI 1
- Asymptomatic bacteriuria should not be treated in most women, as this promotes antimicrobial resistance 4
- Careful evaluation of symptom chronicity is important when the diagnosis is uncertain 1