History and exam

Key diagnostic factors

common

dysuria

Four symptoms and one sign (including dysuria, frequency, hematuria, back pain, costovertebral angle tenderness) significantly increases the probability of UTI.[36]

urinary frequency

Four symptoms and one sign (including dysuria, frequency, hematuria, back pain, costovertebral angle tenderness) significantly increases the probability of UTI.[36]

hematuria

Four symptoms and one sign (including dysuria, frequency, hematuria, back pain, costovertebral angle tenderness) significantly increases the probability of UTI.[36]

back/flank pain

Four symptoms and one sign (including dysuria, frequency, hematuria, back pain, costovertebral angle tenderness) significantly increases the probability of UTI.[36]

costovertebral angle tenderness

When costovertebral angle tenderness is present, a diagnosis of pyelonephritis should be considered.

uncommon

fever

Part of clinical syndrome of pyelonephritis.

Other diagnostic factors

common

urinary urgency

Common symptom. Can also be a sign of an overactive bladder.

suprapubic pain and tenderness

If present, increases the probability of an UTI.[51]

Risk factors

strong

sexual activity

Sexual intercourse is the strongest risk factor.[22]

Any lifetime sexual activity and any sexual activity during the past year are strongly associated with recurrent UTI.[23]

spermicide use

Spermicides, including nonoxynol-9, decrease vaginal lactobacilli, which facilitates vaginal Escherichia coli colonization and results in an increased risk of UTI.[24][25]

Even the relatively small amounts of spermicide coating condoms increases the risk of UTI.[26]

postmenopause

The absence of estrogen (consistent with urogenital atrophy, vaginal atrophy, and also known as genitourinary syndrome of menopause) is a risk factor for UTIs.[27]

Topical intravaginal estrogen treatment reduces UTIs in postmenopausal women;​​​ estrogenization of the vaginal mucosa promotes lactobacilli colonization, which reduces the presence of uropathogens and thus the risk of UTIs.[21][28][29] Conversely, systemic oral estrogen therapy is not associated with benefit related to reduction of recurrent UTIs, and is not recommended over the use of topical estrogen therapy.[29][30]

Sexual activity in postmenopausal women is less strongly associated with UTIs than in younger women.

Urinary incontinence and estrogen supplementation have also been associated with UTI in older women, although the reasons for this are incompletely understood.[31]

positive family history of UTIs

Having a mother with a history of UTIs is associated with a two- to fourfold increase in risk of recurrent UTI.[23]

history of recurrent UTI

A well-established risk factor.[32]

presence of a foreign body

Any indwelling catheter or any foreign body (stone, suture, surgical material, or exposed polypropylene mesh from pelvic surgery) significantly increases risk for UTI.

Foreign bodies serve as nidus for UTIs and interfere with a person's ability to clear a UTI.

Bacteriuria occurs in the presence of indwelling or intermittent catheters, and asymptomatic bacteriuria does not require treatment. When a symptomatic UTI is present in a patient with a catheter or stent, catheter or stent change should be strongly considered.[1]​​

weak

insulin-treated diabetes

Considered a more predominant risk factor in older women.[33]

high lifetime number of UTIs

Considered a more predominant risk factor in older women.[33]

recent antibiotic use

The recent use of certain antimicrobials may predispose women to UTIs through their effects on the genitourinary microbiome.[34][35]

poor bladder emptying

Due to either poor detrusor muscle contraction or bladder outlet obstruction (e.g., secondary to pelvic organ prolapse or a prior anti-incontinence procedure), can lead to urinary stasis, interfering with a person's intrinsic ability to clear bacteriuria.

increasing age

Ten percent of women aged over 70 years have UTIs.[36][37]

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