From the Guidelines
If you're experiencing frequent UTI symptoms but have negative urine cultures and dipstick tests, it's essential to consider alternative diagnoses, such as interstitial cystitis (IC) or bladder pain syndrome, rather than assuming a bacterial infection is present. This condition mimics UTI symptoms, including burning urination, urgency, frequency, and pelvic pain, but isn't caused by bacterial infection 1. According to the ACR Appropriateness Criteria for recurrent lower urinary tract infections in females, imaging is of low yield in patients without underlying risk factors, with less than two episodes per year on average, and who respond promptly to appropriate therapy 1.
Key Considerations
- The patient's symptoms, such as frequency, urgency, and pelvic pain, should be thoroughly evaluated to determine the underlying cause.
- A clean-catch or catheterized specimen for culture typically reveals >100,000 organisms per milliliter of urine, but in this case, the culture is negative 1.
- Escherichia coli is the most common organism in all patient groups, causing approximately 75% of recurrent UTIs, but the absence of a positive culture suggests an alternative diagnosis 1.
Diagnostic Approach
- Consider seeing a urologist or urogynecologist for proper diagnosis and to rule out other conditions that may be causing the symptoms.
- A thorough medical history, physical examination, and additional diagnostic tests, such as cystoscopy or urodynamic studies, may be necessary to confirm the diagnosis.
Treatment Options
- Dietary modifications, such as avoiding acidic foods, caffeine, and alcohol, may help alleviate symptoms.
- Over-the-counter supplements like Prelief can reduce acid in foods and provide relief.
- Prescription medications, such as pentosan polysulfate sodium (Elmiron) at 100mg three times daily, amitriptyline starting at 10-25mg at bedtime, or hydroxyzine 10-25mg as needed, may be effective in managing symptoms.
- Physical therapy for pelvic floor dysfunction and bladder instillations performed by specialists may also be beneficial.
- Stress management techniques are important, as stress often worsens symptoms.
- Staying hydrated and avoiding potential bladder irritants can provide relief.
From the Research
Frequent UTI Symptoms with Negative Culture and Urine Dipstick
- Women with symptoms of a urinary tract infection but a negative urine culture may still have an infection, with studies suggesting that almost all women with typical urinary complaints and a negative culture still have an infection with E. coli 2.
- The use of quantitative PCR (qPCR) for Escherichia coli and Staphylococcus saprophyticus can help identify infections in women with symptoms of a urinary tract infection but a negative culture 2.
- Treatment options for urinary tract infections (UTIs) include nitrofurantoin, fosfomycin, and trimethoprim, with the choice of treatment depending on factors such as renal function and the presence of complications 3, 4, 5, 6.
Treatment Options
- Nitrofurantoin is a commonly used treatment for UTIs, particularly for uncomplicated lower urinary tract infections, and has been shown to be effective in treating E. coli infections 3, 4, 6.
- Fosfomycin is another treatment option for UTIs, particularly for uncomplicated cystitis, and has been shown to be effective in treating E. coli infections 3, 6.
- Trimethoprim is also used to treat UTIs, but its use is limited by increasing resistance among community-acquired E. coli 3, 5.
Considerations for Treatment
- Renal function should be considered when choosing a treatment for UTIs, as some treatments may be more effective in patients with certain levels of renal function 6.
- The presence of complications, such as frequent recurrent UTIs, should also be considered when choosing a treatment 5.
- The choice of treatment should be based on the specific needs of the patient, including the severity of symptoms, the presence of complications, and the patient's medical history 3, 4, 5, 6.