Diagnosis and Treatment of Urinary Tract Infection
You have a urinary tract infection (UTI) that requires antibiotic treatment, with first-line options being nitrofurantoin for 5 days, trimethoprim/sulfamethoxazole for 3 days, or fosfomycin as a single dose. 1
Clinical Diagnosis
Your symptoms of burning sensation (dysuria) and yellow discharge in urine strongly suggest a UTI, particularly cystitis (bladder infection). 2, 1
For women with typical UTI symptoms—dysuria, frequency, urgency, and suprapubic pain—without vaginal discharge, self-diagnosis is accurate enough to start treatment without further testing. 1, 3
- The most diagnostic symptoms include change in urinary frequency, dysuria (burning), urgency, and absence of vaginal discharge 3
- Yellow discharge in urine typically represents pyuria (white blood cells in urine), which indicates inflammation and infection 2
- Dysuria combined with frequency and urgency, without vaginal discharge, has high diagnostic accuracy for UTI 2, 3
When Testing Is Needed
You do NOT need urine culture or urinalysis if this is your first uncomplicated UTI with typical symptoms. 1
However, urine culture and susceptibility testing should be obtained if you have: 1, 3
- Recurrent infections
- Treatment failure
- History of resistant bacteria
- Atypical presentation
- Pregnancy
- Male gender
- Age ≥65 years
First-Line Antibiotic Treatment
Choose one of these evidence-based first-line options: 1
- Nitrofurantoin: 5 days duration 1
- Trimethoprim/sulfamethoxazole (Bactrim): 3 days duration (only if local resistance <20%) 4, 1, 3
- Trimethoprim alone: 3 days duration 1
- Fosfomycin: Single dose 1, 3
These antibiotics have minimal collateral damage, low resistance rates, and excellent efficacy for uncomplicated UTI. 1, 3
Symptomatic Relief
Phenazopyridine (urinary analgesic) can provide immediate relief of burning sensation while antibiotics work. 5
- This medication produces reddish-orange discoloration of urine and may stain fabric 5
- Nonsteroidal anti-inflammatory drugs (NSAIDs) also provide effective symptomatic relief 1
Critical Pitfalls to Avoid
Do NOT use first-generation cephalosporins (like cephalexin) if Group B Streptococcus is suspected, as they have inadequate coverage. 6
Do NOT treat asymptomatic bacteriuria (bacteria in urine without symptoms)—this promotes antibiotic resistance without clinical benefit. 2, 6
Fluoroquinolones (ciprofloxacin, levofloxacin) should NOT be used as first-line therapy due to increasing resistance and unnecessary broad-spectrum coverage. 2, 3
When to Seek Urgent Care
Return for evaluation within 48 hours if you develop: 2
- Fever (temperature >38°C/100.4°F)
- Flank pain or costovertebral angle tenderness
- Nausea, vomiting, or inability to retain oral medications
- Worsening symptoms despite 48-72 hours of antibiotics
These symptoms suggest pyelonephritis (kidney infection) or complicated UTI requiring different management. 2
Special Considerations for Men
If you are male, you MUST obtain urine culture before starting antibiotics, as all UTIs in men are considered complicated. 1, 7
- Men require 7 days of treatment (not 3-5 days) 1
- Consider prostatitis if symptoms persist, which requires 14 days of treatment 2
- Urethritis should be ruled out if urethral discharge is prominent 2
Prevention of Recurrence
If you experience recurrent UTIs (≥2 infections in 6 months or ≥3 in 12 months), consider: 1
- Increased fluid intake
- Cranberry products
- Methenamine hippurate
- Antibiotic prophylaxis (though this carries risks of resistance and adverse effects) 1