Urinary tract infections in women - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Urinary tract infections in women can be clinically categorized into uncomplicated/complicated, acute, or recurrent.
Escherichia coli is the most common organism in uncomplicated infections.
Costovertebral angle tenderness together with fever suggests pyelonephritis.
Diagnosed using urine dipstick, microscopic urinalysis (bacteria, white blood cell, red blood cell), and urine culture.
Antibiotic selection should be guided by local bacterial susceptibilities and guidelines, or based on known urine culture and sensitivity.

Quick Reference

History & Exam
- Key Factors
- Other Factors
More information...
Diagnostics Tests
More information...
Treatment Options
More information...

Definition

Epidemiology

Etiology

Pathophysiology

Citations

Key Articles

European Association of Urology. EAU guidelines on urological infections. Mar 2023 [internet publication].[Full Text]
Nicolle LE, Gupta K, Bradley SF, et al. Clinical practice guideline for the management of asymptomatic bacteriuria: 2019 update by the Infectious Diseases Society of America. Clin Infect Dis. 2019 Mar 21.[Abstract][Full Text]
Bent S, Nallamothu BK, Simel DL, et al. Does this woman have an acute uncomplicated urinary tract infection? JAMA. 2002 May 22-29;287(20):2701-10.[Abstract]
Gupta K, Hooton TM, Naber KG, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011 Mar 1;52(5):e103-20.[Abstract][Full Text]

Referenced Articles

1. European Association of Urology. EAU guidelines on urological infections. Mar 2023 [internet publication].[Full Text]
2. Anger J, Lee U, Ackerman AL, et al. Recurrent uncomplicated urinary tract infections in women: AUA/CUA/SUFU guideline. J Urol. 2019 Aug;202(2):282-289.[Abstract][Full Text]
3. Nicolle LE. The Paradigm Shift to Non-Treatment of Asymptomatic Bacteriuria. Pathogens. 2016 Apr 19;5(2). pii: E38.[Abstract][Full Text]
4. Cortes-Penfield NW, Trautner BW, Jump RLP. Urinary tract infection and asymptomatic bacteriuria in older adults. Infect Dis Clin North Am. 2017 Dec;31(4):673-88.[Abstract][Full Text]
5. Zalmanovici Trestioreanu A, Lador A, Sauerbrun-Cutler MT, et al. Antibiotics for asymptomatic bacteriuria. Cochrane Database Syst Rev. 2015 Apr 8;(4):CD009534.[Abstract][Full Text]
6. Nicolle LE, Gupta K, Bradley SF, et al. Clinical practice guideline for the management of asymptomatic bacteriuria: 2019 update by the Infectious Diseases Society of America. Clin Infect Dis. 2019 Mar 21.[Abstract][Full Text]
7. Schappert SM. National Ambulatory Medical Care Survey: 1992 summary. Adv Data. 1994 Aug 18;(253):1-20.[Abstract][Full Text]
8. Foxman B, Barlow R, D'Arcy H, et al. Urinary tract infection: self-reported incidence and associated costs. Ann Epidemiol. 2000 Nov;10(8):509-15.[Abstract]
9. Mabeck CE. Treatment of uncomplicated urinary tract infection in non-pregnant women. Postgrad Med J. 1972 Feb;48(556):69-75.[Abstract]
10. Ronald AR, Nicolle LE, Stamm E, et al. Urinary tract infection in adults: research priorities and strategies. Int J Antimicrob Agents. 2001 Apr;17(4):343-8.[Abstract]
11. Stamm WE, Hooton TM. Management of urinary tract infections in adults. N Engl J Med. 1993 Oct 28;329(18):1328-34.[Abstract]
12. Nicolle LE. A practical guide to the management of complicated urinary tract infection. Drugs. 1997 Apr;53(4):583-92.[Abstract]
13. Concia E, Bragantini D, Mazzaferri F. Clinical evaluation of guidelines and therapeutic approaches in multi drug-resistant urinary tract infections. J Chemother. 2017 Dec;29(supl 1):19-28.[Abstract][Full Text]
14. Bader MS, Loeb M, Brooks AA. An update on the management of urinary tract infections in the era of antimicrobial resistance. Postgrad Med. 2017 Mar;129(2):242-58. [Abstract]
15. Czaja CA, Hooton TM. Update on acute uncomplicated urinary tract infection in women. Postgrad Med. 2006 Jun-Jul;119(1):39-45.[Abstract]
16. Neu HC. Urinary tract infections. Am J Med. 1992 Apr 6;92(4A):63S-70S.[Abstract]
17. Safir MH, Schaeffer AJ. Urinary tract infection: simple and complicated. AUA Update series. 1997;16:10.
18. Flores-Mireles AL, Walker JN, Caparon M, et al. Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nat Rev Microbiol. 2015 May;13(5):269-84. [Abstract][Full Text]
19. Raz R, Stamm WE. A controlled trial of intravaginal estriol in postmenopausal women with recurrent urinary tract infections. N Engl J Med. 1993 Sep 9;329(11):753-6.[Abstract]
20. Hooton TM. Epidemiology. In: Stanton SL, Dwyer PL, eds. Urinary tract infection in the female. London: Martin Dunitz Ltd; 2000.
21. Scholes D, Hooton TM, Roberts PL, et al. Risk factors for recurrent urinary tract infection in young women. J Infect Dis. 2000 Oct;182(4):1177-82.[Abstract][Full Text]
22. Gupta K, Hillier SL, Hooton TM, et al. Effects of contraceptive method on the vaginal microbial flora: a prospective evaluation. J Infect Dis. 2000 Feb;181(2):595-601.[Abstract]
23. Eschenbach DA, Patton DL, Hooton TM, et al. Effects of vaginal intercourse with and without a condom on vaginal flora and vaginal epithelium. J Infect Dis. 2001 Mar 15;183(6):913-8.[Abstract]
24. Fihn SD, Boyko EJ, Chen CL, et al. Use of spermicide-coated condoms and other risk factors for urinary tract infection caused by Staphylococcus saprophyticus. Arch Intern Med. 1998 Feb 9;158(3):281-7.[Abstract]
25. Stamm WE, Raz R. Factors contributing to susceptibility of postmenopausal women to recurrent urinary tract infections. Clin Infect Dis. 1999 Apr;28(4):723-5.[Abstract]
26. Cardozo L, Lose G, McClish D, et al. A systematic review of estrogens for recurrent urinary tract infections: third report of the hormones and urogenital therapy (HUT) committee. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12(1):15-20.[Abstract]
27. Perrotta C, Aznar M, Mejia R, et al. Oestrogens for preventing recurrent urinary tract infection in postmenopausal women. Cochrane Database Syst Rev. 2008 Apr 16;(2):CD005131.[Abstract][Full Text]
28. Trinkaus M, Chin S, Wolfman W, et al. Should urogenital atrophy in breast cancer survivors be treated with topical estrogens? Oncologist. 2008 Mar;13(3):222-31.[Abstract][Full Text]
29. Hu KK, Boyko EJ, Scholes D, et al. Risk factors for urinary tract infections in postmenopausal women. Arch Intern Med. 2004 May 10;164(9):989-93.[Abstract][Full Text]
30. Hooton TM, Scholes D, Hughes JP, et al. A prospective study of risk factors for symptomatic urinary tract infection in young women. N Engl J Med. 1996 Aug 15;335(7):468-74.[Abstract]
31. Jackson SL, Boyko EJ, Scholes D, et al. Predictors of urinary tract infection after menopause: a prospective study. Am J Med. 2004 Dec 15;117(12):903-11.[Abstract]
32. Hooton TM, Stamm WE. The vaginal flora and UTIs: molecular pathogenesis and clinical management. Washington, DC: ASM Press; 1996:67-94.
33. Smith HS, Hughes JP, Hooton TM, et al. Antecedent antimicrobial use increases the risk of uncomplicated cystitis in young women. Clin Infect Dis. 1997 Jul;25(1):63-8.[Abstract]
34. Bent S, Nallamothu BK, Simel DL, et al. Does this woman have an acute uncomplicated urinary tract infection? JAMA. 2002 May 22-29;287(20):2701-10.[Abstract]
35. Car J. Urinary tract infections in women: diagnosis and management in primary care. BMJ. 2006 Jan 14;332(7533):94-7.[Abstract]
36. Wagenlehner FM, Weidner W, Naber KG. An update on uncomplicated urinary tract infections in women. Curr Opin Urol. 2009Jul;19(4):368-74.[Abstract]
37. National Institute for Health and Care Excellence. Urinary tract infections in adults. June 2015 [internet publication].[Full Text]
38. Public Health England. Guidance for primary care on diagnosing and understanding culture results for urinary tract infection (UTI). November 2018 [internet publication].[Full Text]
39. Little P, Turner S, Rumsby K, et al. Developing clinical rules to predict urinary tract infection in primary care settings: sensitivity and specificity of near patient tests (dipsticks) and clinical scores. Br J Gen Pract. 2006 Aug;56(529):606-12.[Abstract][Full Text]
40. Little P, Turner S, Rumsby K, et al. Dipsticks and diagnostic algorithms in urinary tract infection: development and validation, randomised trial, economic analysis, observational cohort and qualitative study. Health Technol Assess. 2009 Mar;13(19):iii-iv, ix-xi, 1-73. [Abstract][Full Text]
41. Hooton TM, Stamm WE. Diagnosis and treatment of uncomplicated urinary tract infection. Infect Dis Clin North Am. 1997 Sep;11(3):551-81.[Abstract]
42. Wilson ML, Gaido L. Laboratory diagnosis of urinary tract infections in adult patients. Clin Infect Dis. 2004 Apr 15;38(8):1150-8.[Abstract][Full Text]
43. Schmiemann G, Kniehl E, Gebhardt K, et al. The diagnosis of urinary tract infection: a systematic review. Dtsch Arztebl Int. 2010 May 28;107(21):361-7.[Abstract][Full Text]
44. Browne RF, Zwirewich C, Torreggiani WC. Imaging of urinary tract infection in the adult. Eur Radiol. 2004 Mar;14 (suppl 3):E168-83.[Abstract]
45. Köves B, Cai T, Veeratterapillay R, et al. Benefits and harms of treatment of asymptomatic bacteriuria: a systematic review and meta-analysis by the European Association of Urology Urological Infection Guidelines Panel. Eur Urol. 2017 Dec;72(6):865-8.[Abstract][Full Text]
46. The American College of Obstetricians and Gynecologists. Urinary tract infections in pregnant individuals. Obstet Gynecol. 2023 Aug 1;142(2):435-45.[Abstract][Full Text]
47. American College of Radiology. ACR appropriateness criteria: acute pyelonephritis. 2022 [internet publication].[Full Text]
48. American College of Radiology. ACR appropriateness criteria: recurrent lower urinary tract infections in women. 2020 [internet publication].[Full Text]
49. American College of Radiology. ACR Appropriateness Criteria: Hematuria. 2019 [internet publication].[Full Text]
50. Epp A, Larochelle A. No. 250-recurrent urinary tract infection. J Obstet Gynaecol Can. 2017 Oct;39(10):e422-31.[Abstract]
51. Zalmanovici TA, Green H, Paul M, et al. Antimicrobial agents for treating uncomplicated urinary tract infection in women. Cochrane Database Syst Rev. 2010 Oct 6;(10):CD007182.[Abstract][Full Text]
52. Gupta K, Hooton TM, Naber KG, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011 Mar 1;52(5):e103-20.[Abstract][Full Text]
53. Dawson-Hahn EE, Mickan S, Onakpoya I, et al. Short-course versus long-course oral antibiotic treatment for infections treated in outpatient settings: a review of systematic reviews. Fam Pract. 2017 Sep 1;34(5):511-9.[Abstract][Full Text]
54. Huttner A, Kowalczyk A, Turjeman A, et al. Effect of 5-day nitrofurantoin vs single-dose fosfomycin on clinical resolution of uncomplicated lower urinary tract infection in women: a randomized clinical trial. JAMA. 2018 May 1;319(17):1781-9.[Abstract][Full Text]
55. Tamma PD, Aitken SL, Bonomo RA, et al. Infectious Diseases Society of America 2023 guidance on the treatment of antimicrobial resistant gram-negative infections. Clin Infect Dis. 2023 Jul 18:ciad428.[Abstract][Full Text]
56. O'Brien KA, Zhang J, Mauldin PD, et al. Impact of a stewardship-initiated restriction on empirical use of ciprofloxacin on nonsusceptibility of Escherichia coli urinary isolates to ciprofloxacin. Pharmacotherapy. 2015 May;35(5):464-9.[Abstract]
57. US Food and Drug Administration. Fluoroquinolone antibacterial drugs: drug safety communication - FDA advises restricting use for certain uncomplicated infections. July 2016 [internet publication].[Full Text]
58. Gágyor I, Bleidorn J, Kochen MM, et al. Ibuprofen versus fosfomycin for uncomplicated urinary tract infection in women: randomised controlled trial. BMJ. 2015 Dec 23;351:h6544.[Abstract][Full Text]
59. Kronenberg A, Bütikofer L, Odutayo A, et al. Symptomatic treatment of uncomplicated lower urinary tract infections in the ambulatory setting: randomised, double blind trial. BMJ. 2017 Nov 7;359:j4784.[Abstract][Full Text]
60. Brown KA, Khanafer N, Daneman N, et al. Meta-analysis of antibiotics and the risk of community-associated Clostridium difficile infection. Antimicrob Agents Chemother. 2013 May;57(5):2326-32.[Abstract][Full Text]
61. van Nieuwkoop C, van der Starre WE, Stalenhoef JE, et al. Treatment duration of febrile urinary tract infection: a pragmatic randomized, double-blind, placebo-controlled non-inferiority trial in men and women. BMC Med. 2017 Apr 3;15(1):70.[Abstract][Full Text]
62. Bader MS, Hawboldt J, Brooks A. Management of complicated urinary tract infections in the era of antimicrobial resistance. Postgrad Med. 2010 Nov;122(6):7-15.[Abstract]
63. Medicines and Healthcare products Regulatory Agency. Nitrofurantoin: reminder of the risks of pulmonary and hepatic adverse drug reactions. Apr 2023 [internet publication].[Full Text]
64. Ward K, Theiler RN. Once-daily dosing of gentamicin in obstetrics and gynecology. Clin Obstet Gynecol. 2008;51(3):498-506.[Abstract][Full Text]
65. Lee M, Bozzo P, Einarson A, et al. Urinary tract infections in pregnancy. Can Fam Physician. 2008;54(6):853-4.[Abstract][Full Text]
66. Committee on Obstetric Practice. Committee opinion no. 717: sulfonamides, nitrofurantoin, and risk of birth defects. Obstet Gynecol. 2017 Sep;130(3):e150-52.[Abstract]
67. Damiano R, Quarto G, Bava I, et al. Prevention of recurrent urinary tract infections by intravesical administration of hyaluronic acid and chondroitin sulphate: a placebo-controlled randomised trial. Eur Urol. 2011 Apr;59(4):645-51.[Abstract]
68. Ahmed H, Davies F, Francis N, et al. Long-term antibiotics for prevention of recurrent urinary tract infection in older adults: systematic review and meta-analysis of randomised trials. BMJ Open. 2017 May 29;7(5):e015233.[Abstract][Full Text]
69. Gupta K, Sahm DF, Mayfield D, et al. Antimicrobial resistance among uropathogens that cause community-acquired urinary tract infections in women: a nationwide analysis. Clin Infect Dis. 2001 Jul 1;33(1):89-94.[Abstract]
70. Gupta K, Hooton TM, Roberts PL, et al. Patient-initiated treatment of uncomplicated recurrent urinary tract infections in young women. Ann Intern Med. 2001 Jul 3;135(1):9-16.[Abstract]
71. Stapleton AE. The vaginal microbiota and urinary tract infection. Microbiol Spectr. 2016 Dec;4(6):.[Abstract][Full Text]
72. Dueñas-Garcia OF, Sullivan G, Hall CD, et al. Pharmacological agents to decrease new episodes of recurrent lower urinary tract infections in postmenopausal women. A systematic review. Female Pelvic Med Reconstr Surg. 2016 Mar-Apr;22(2):63-9.[Abstract]
73. European Medicines Agency. Four-week limit for use of high-strength estradiol creams. October 2019 [internet publication].[Full Text]
74. Hickling DR, Nitti VW. Management of recurrent urinary tract infections in healthy adult women. Rev Urol. 2013;15(2):41-8.[Abstract][Full Text]
75. Castanheira M, Huband MD, Mendes RE, et al. Meropenem-vaborbactam tested against contemporary Gram-negative isolates collected worldwide during 2014, including carbapenem-resistant, KPC-producing, multidrug-resistant, and extensively drug-resistant Enterobacteriaceae. Antimicrob Agents Chemother. 2017 Aug 24; 61: e00567-17.[Abstract]
76. Cox G, Ejim L, Stogios PJ, et al. Plazomicin retains antibiotic activity against most aminoglycoside modifying enzymes. ACS Infect Dis. 2018 Jun 8;4(6):980-7.[Abstract]
77. Wagenlehner FME, Cloutier DJ, Komirenko AS, et al. Once-daily plazomicin for complicated urinary tract infections. N Engl J Med. 2019 Feb 21;380(8):729-40.[Abstract][Full Text]
78. Stapleton A. Novel approaches to prevention of urinary tract infections. Infect Dis Clin North Am. 2003 Jun;17(2):457-71.[Abstract]
79. Cruz F, Dambros M, Naber KG, et al. Recurrent urinary tract infections: Uro-Vaxom, a new alternative. Eur Urol Suppl. 2009;8(9):762-8.
80. Huttner A, Hatz C, van den Dobbelsteen G, et al. Safety, immunogenicity, and preliminary clinical efficacy of a vaccine against extraintestinal pathogenic Escherichia coli in women with a history of recurrent urinary tract infection: a randomised, single-blind, placebo-controlled phase 1b trial. Lancet Infect Dis. 2017 May;17(5):528-37.[Abstract]
81. Yang B, Foley S. First experience in the UK of treating women with recurrent urinary tract infections with the bacterial vaccine Uromune®. BJU Int. 2018 Feb;121(2):289-92. [Abstract]
82. Abad CL, Safdar N. The role of lactobacillus probiotics in the treatment or prevention of urogenital infections - a systematic review. J Chemother. 2009 Jun;21(3):243-52.[Abstract]
83. Beerepoot MA, ter Riet G, Nys S, et al. Lactobacilli vs antibiotics to prevent urinary tract infections: a randomized, double-blind, noninferiority trial in postmenopausal women. Arch Intern Med. 2012 May 14;172(9):704-12.[Abstract]
84. Reid G, Bruce AW, Taylor M. Influence of three-day antimicrobial therapy and lactobacillus vaginal suppositories on recurrence of urinary tract infections. Clin Ther. 1992 Jan-Feb;14(1):11-6.[Abstract]
85. Baerheim A, Larsen E, Digranes A. Vaginal application of lactobacilli in the prophylaxis of recurrent lower urinary tract infection in women. Scand J Prim Health Care. 1994 Dec;12(4):239-43.[Abstract]
86. Domenici L, Monti M, Bracchi C, et al. D-mannose: a promising support for acute urinary tract infections in women. A pilot study. Eur Rev Med Pharmacol Sci. 2016 Jul;20(13):2920-5.[Abstract][Full Text]
87. Kranjčec B, Papeš D, Altarac S. D-mannose powder for prophylaxis of recurrent urinary tract infections in women: a randomized clinical trial. World J Urol. 2014 Feb;32(1):79-84.[Abstract]
88. Bonkat G, Cai T, Veeratterapillay R, et al. Management of urosepsis in 2018. Eur Urol Focus. 2018 Nov 15;5(1):5-9.[Abstract][Full Text]
89. Coelho RF, Schneider-Monteiro ED, Mesquita JL, et al. Renal and perinephric abscesses: analysis of 65 consecutive cases. World J Surg. 2007 Feb;31(2):431-6.[Abstract]
90. Avorn J, Monane M, Gurwitz JH, et al. Reduction of bacteriuria and pyuria after ingestion of cranberry juice. JAMA. 1994 Mar 9;271(10):751-4.[Abstract]
91. Nicolle LE. Urinary tract infection in long-term-care facility residents. Clin Infect Dis. 2000 Sep;31(3):757-61.[Abstract]
92. Miller JL, Krieger JN. Urinary tract infections: cranberry juice, underwear, and probiotics in the 21st century. Urol Clin North Am. 2002 Aug;29(3):695-9.[Abstract]
93. Williams G, Hahn D, Stephens JH, et al. Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev. 2023 Apr 17;4(4):CD001321.[Abstract]
94. Wang CH, Fang CC, Chen NC, et al. Cranberry-containing products for prevention of urinary tract infections in susceptible populations: a systematic review and meta-analysis of randomized controlled trials. Arch Intern Med. 2012 Jul 9;172(13):988-96.[Abstract][Full Text]
95. Occhipinti A, Germano A, Maffei ME. Prevention of urinary tract infection with Oximacro, a cranberry extract with a high content of A-type proanthocyanidins: a pre-clinical double-blind controlled study. Urol J. 2016 Apr 16;13(2):2640-9.[Abstract]
96. Foxman B, Cronenwett AE, Spino C, et al. Cranberry juice capsules and urinary tract infection after surgery: results of a randomized trial. Am J Obstet Gynecol. 2015 Aug;213(2):194.e1-8.[Abstract][Full Text]
97. Maki KC, Kaspar KL, Khoo C, et al. Consumption of a cranberry juice beverage lowered the number of clinical urinary tract infection episodes in women with a recent history of urinary tract infection. Am J Clin Nutr. 2016 Jun;103(6):1434-42.[Abstract]