Are urinary tract infections really that straightforward?

For a long time, urinary tract infections have been treated as though they are simple, garden-variety ailment that is straightforward to treat. This seems to be the attitude of both the doctors treating them and many of the women suffering from them: oh well, another UTI, better get to the doctor and get antibiotics!

Recent research seems to show that UTIs are not as clear-cut as we might have thought – they are more complex both in the diagnosis and treatment.

An overview of studies on urinary tract infections recently came up with some interesting findings.

Pyuria – it sounds nicer than “pus in the urine”

Pyuria charmingly means ‘’pus cells in the urine’’ and is the common finding where the square on the dipstick turns purple.

Pyuria has been thought to be a strong indicator of a urinary tract infection. In very few cases, women with UTIs do not have pyuria. However, in almost 40% of cases, pyuria was found where a UTI was not diagnosed. That is, there was a ‘’positive dipstick’’ (indicating pyuria) but when a culture was done, the lab could not confirm an infection.

What does this mean? It could mean that these women indeed were free of infection, and that there was another cause of the white blood cells in the urine. It could be that these women had recently already started on antibiotic treatment, and it had sufficiently ‘’killed off’’ the bugs to make culture difficult.

But, intriguingly, there is a third possibility.

It is equally possible that there was actually an infection, but the lab technique was unable to culture it sufficiently to reach the level required for a true UTI diagnosis.

This latter explanation has been proposed by researching urologist Professor James Malone-Lee, who points out that original ‘’cut-offs’’ for UTI were based on just seventy-four women, who had been hospitalised with pyelonephritis (severe kidney infection), which may actually be a different kettle of fish to a ‘’plain old UTI’’.

Intrigued? Watch this space for part 2: “The Gray Area of UTIs”, where the plot thickens!



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