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The world of UTI is not as simple as it seems

There may be more to it than you think. Despite urinary tract infection (UTI) being so common, diagnosis can be difficult as the symptoms seen with different types of UTI can also be seen with other conditions affecting the urogenital tract.1-4 This may be concerning, since about 1 in 10 women experience an uncomplicated UTI (uUTI) annually, with more than 75% caused by Escherichia coli.5,6

Differential diagnoses hero image
Differential diagnoses hero image
Differential Diagnoses
Recurrent uUTI

UTI vs other urogenital conditions

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    DIFFERENTIAL DIAGNOSIS

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    Urinary Tract Infections

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    UTI

    NARRATOR:

    The world of UTI…

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    UTI

    NARRATOR:

    …may not be as simple as it seems.

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    About 1 in 8 women experience a uUTI annually
    uUTI=uncomplicated UTI.

    NARRATOR:

    About 1 in 8 women experience an uncomplicated UTI annually…

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    uUTIs
    >75%
    Are caused by E. coli

    NARRATOR:

    …with more than 75% of uncomplicated UTIs caused by uropathogenic strains of Escherichia coli, also known as E. coli.

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    UTI is common

    Diagnoisis can be difficult

    UTI=Urinary tract infection.

    NARRATOR:

    Despite urinary tract infection being so common, diagnosis can be difficult as the symptoms seen with UTI can also be seen with other conditions affecting the urogenital tract.

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    uUTI vs. Complicated UTI

    NARRATOR:

    Let’s dive deeper.
    Uncomplicated UTI, also called acute cystitis, is an infection of the bladder, or lower urinary tract, whereas pyelonephritis is an infection of the kidneys, or upper urinary tract, and is considered a complicated UTI.

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    How uUTI differs from other causes of dysuria

    • Occurs in otherwise healthy women
    • Limited to the bladder/lower urinary tract
    • Dysuria
    • Urinary frequency or urgency
    • Suprapubic pain
    • Typically do not experience fever, flank pain or vaginal symptoms

    NARRATOR:

    Uncomplicated UTIs occur in otherwise healthy women and are limited to the bladder and lower urinary tract.

    Patients often experience dysuria and urinary frequency or urgency, along with suprapubic pain. They typically do not experience fever, flank pain or vaginal symptoms.

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    Complicated UTI

    • Extends beyond the bladder to upper urinary tract
    • Dysuria
    • Fever (100.4°F/38°C)
    • Chills, rigors
    • Flank pain
    • Costovertebral angle tenderness
    • Malaise
    • Nausea or vomiting

    NARRATOR:

    Complicated UTIs:
    Extend beyond the bladder to the upper urinary tract. In addition to dysuria and urinary frequency and urgency, there may be:

    • Fever
    • Chills
    • Flank pain
    • Costovertebral angle tenderness
    • Malaise, and
    • Nausea or vomiting.

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    uUTI symptoms can cause uUTI to be confused with other conditions such as
    Vaginitis
    Urethritis

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    Patients with uncomplicated UTI often experience symptoms such as dysuria that can be confused with other conditions, including vaginitis and urethritis.

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    Vaginitis

    • Limited to the vagina
    • Dysuria without urinary frequency or urgency
    • Presence of vaginal discharge or odor
    • Puritus
    • Dyspareunia
    • Can be caused by bacterial vaginosis, vulvovaginal candidiasis, and trichomoniasis

    NARRATOR:

    Vaginitis is limited to the vagina and can include:

    • Dysuria without urinary frequency or urgency
    • The presence of vaginal discharge or odor
    • Pruritus
    • Dyspareunia
    • And can be caused by bacterial vaginosis, vulvovaginal candidiasis, and trichomoniasis.

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    Urethritis

    • Limited to the urethra 
    • Dysuria in sexually active females 
    • Pyuria on urinalysis but no bacteriuria
    • Can be caused by chlamydia, gonorrhea, trichomoniasis, Candida species, herpes simplex virus and irritants like contraceptive gel

    NARRATOR:

    Urethritis is a condition limited to the urethra and characterized by:

    • Dysuria in sexually active females
    • Pyuria on urinalysis but no bacteriuria
    • And can be caused by chlamydia, gonorrhea, trichomoniasis, Candida species, herpes simplex virus, and irritants like contraceptive gel

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    An estimated 30%-44% of women who have a uUTI are likely to have another, often within three months.

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    Women who have uncomplicated UTIs are also at risk for recurrence. An estimated 30-44% of women who have an uncomplicated UTI are likely to have another, often within three months.

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    6 MONTHS
    12 MONTHS

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    Recurrence is generally defined as 2 uncomplicated UTIs in 6 months or 3 in a year.

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    Relapse

    Recurrence with the same uropathogen within 2 weeks of finishing appropriate antibiotic therapy

    Reinfection

    Recurrence >2 weeks after successful treatment, even if the infecting uropathogen is the same as the original

    NARRATOR:

    Relapse and reinfection further define recurrence by their timing relative to the initial infection. Consider these definitions to help determine if your patient may be experiencing a relapse or a reinfection.

    • Relapse is defined as a recurrence with the same uropathogen within 2 weeks of finishing appropriate antibiotic therapy.
    • Relapse may require further investigation to determine the reason for failure of initial therapy.
    • Reinfection is defined as recurrence more than 2 weeks after successful treatment, even if the infecting uropathogen is the same as the original.

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    DIFFERENTIAL DIAGNOSIS

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    Knowing how uncomplicated UTI differs from other causes of dysuria can help guide the successful management of UTI.

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    More To UTI

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    There may be more to UTI than you think.

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    1. Uncomplicated urinary tract infections: developing drugs for treatment guidance for industry. Center for Drug Evaluation and Research. August 2019. Accessed June 17, 2023. https://www.fda.gov/regulatory-information/search-fda-guidance-documents/uncomplicated-urinary-tract-infections-developing-drugs-treatment-guidance-industry. 2. Complicated urinary tract infections: developing drugs for treatment guidance for industry. Center for Drug Evaluation and Research. June 2018. Accessed June 17, 2023. https://www.fda.gov/regulatory-information/search-fda-guidance-documents/complicated-urinary-tract-infections-developing-drugs-treatment. 3. Michels TC, Sands JE. Am Fam Physician. 2015;92(9):778-786. 4. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No.215. Obstet Gynecol. 2020;135(1):e1-e17. 5. Foxman B, Brown P. Epidemiology of urinary tract infections: transmission and risk factors, incidence, and costs. Infect Dis Clin North Am. 2003;17(2):227-241. 6. Hooton TM. NEJM. 2012;366(11):56-65. 7. Foxman B. The epidemiology of urinary tract infection. Nat Rev Urol. 2010;7(12):653-660. 8. Markowitz MA, Wood LN, Raz S, et al. Int Urogynecol J. 2019;30(7):1187-1194. 9. Gupta K, Hooton TM, Naber KG, et al. Clin Infect Dis. 2011;52(5):e103-e120. 10. Gupta K, Trautner BW. BMJ. 2013;346:f3140. 11. Anger J, Lee U, Ackerman LA, et al. Recurrent uncomplicated urinary tract infections in women: AUA/CUA/SUFU Guideline. American Urological Association. Published 2019. Updated 2022. Accessed April 2, 2023. https://www.auanet.org/guidelines-and-quality/guidelines/recurrent-uti. 12. Brubaker L, Carberry C, Nardos R, Carter-Brooks C, et al. Female Pelvic Med Reconstr Surg. 2018;24(5):321-335.

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How uUTI differs from other causes of dysuria

Differential diagnoses of urinary tract infections and dysuria

uUTI, also called acute cystitis, is an infection in the bladder or lower urinary tract, whereas pyelonephritis is an infection of the upper urinary tract and is considered a complicated UTI.1,2

Uncomplicated UTI image

Uncomplicated UTI1,7

  • Occurs in otherwise healthy women
  • Limited to the bladder/lower urinary tract
  • Dysuria
  • Urinary frequency or urgency
  • Suprapubic pain
  • No fever or flank pain
  • No vaginal symptoms
Complicated UTI image

Complicated UTI2

  • Extends beyond the bladder to the upper urinary tract
  • Fever (100.4°F/38°C)
  • Dysuria
  • Urinary frequency or urgency
  • Chills, rigors
  • Flank pain
  • Costovertebral angle tenderness
  • Malaise
  • Nausea or vomiting 

Patients with uUTI often experience symptoms such as dysuria that can be confused with other conditions, including vaginitis and urethritis.3

Vaginitis image

Vaginitis3,4

  • Limited to vagina
  • Dysuria, but absence of urinary frequency or urgency
  • Presence of vaginal discharge or odor
  • Pruritus
  • Dyspareunia
  • Caused by bacterial vaginosis, vulvovaginal candidiasis, and trichomoniasis
Urethritis image

Urethritis3

  • Limited to the urethra
  • Dysuria in sexually active females
  • Pyuria on urinalysis but no bacteriuria
  • Caused by chlamydia, gonorrhea, trichomoniasis, Candida species, herpes simplex virus, and irritants like contraceptive gel

Risk for infection with drug-resistant organisms is a consideration for both uUTI and complicated UTI.8

30% to 44% of women who have a uUTI will have a recurrence9,10

Recurrent UTI definition
Recurrent UTI definition

Recurrence is generally defined as
2 uUTIs in 6 months or 3 in a year.11,12 Relapse and reinfection further define recurrence by their timing relative to the initial infection. Consider these definitions to help determine if your patient is experiencing:

  • Relapse: Recurrence with the same uropathogen within 2 weeks of finishing therapy for
    the same uropathogen suggests failure of the initial therapy, either because the antimicrobial failed or another complicating factor may be present
  • Reinfection: Recurrence >2 weeks after treatment, even if the infecting uropathogen is the same as the original

Explore UTI Challenges

  1. Uncomplicated urinary tract infections: developing drugs for treatment guidance for industry. Center for Drug Evaluation and Research. August 2019. Accessed August 14, 2023. https://www.fda.gov/regulatory-information/search-fda-guidance-documents/uncomplicated-urinary-tract-infections-developing-drugs-treatment-guidance-industry
  2. Complicated urinary tract infections: developing drugs for treatment. Center for Drug Evaluation and Research. June 2018. Accessed August 14, 2023. https://www.fda.gov/regulatory-information/search-fda-guidance-documents/complicated-urinary-tract-infections-developing-drugs-treatment
  3. Michels TC, Sands JE. Dysuria: evaluation and differential diagnosis in adults. Am Fam Physician. 2015;92(9):778-786.
  4. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 215. Clinical management of guidelines for obstetrician-gynecologists. Vaginitis in nonpregnant patients. Obstet Gynecol. 2020;135(1):e1-e17.
  5. Kaye KS, Gupta V, Mulgirigama A, et al. Antimicrobial resistance trends in urine Escherichia coli isolates from adult and adolescent females in the United States from 2011 to 2019: rising ESBL strains and impact on patient management. Clin Infect Dis. 2021;73(11):1992-1999.
  6. Hooton TM. Uncomplicated urinary tract infection. N Engl J Med. 2012;366(11):1028-1037.
  7. Markowitz MA, Wood LN, Raz S, et al. Lack of uniformity among United States recommendations for diagnosis and management of acute, uncomplicated cystitis. Int Urogynecol J. 2019;30(7):1187-1194.
  8. 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;52(5):e103-e120.
  9. Gupta K, Trautner BW. Diagnosis and management of recurrent urinary tract infections in non-pregnant women. BMJ. 2013;346:f3140.
  10. Foxman B. Recurring urinary tract infection: incidence and risk factors. Am J Public Health. 1990;80(3):331-333.
  11. Anger J, Lee U, Ackerman LA, et al. Recurrent uncomplicated urinary tract infections in women: AUA/CUA/SUFU Guideline. American Urological Association. Published 2019. Updated 2022. Accessed April 2, 2023. https://www.auanet.org/guidelines-and-quality/guidelines/recurrent-uti
  12. Brubaker L, Carberry C, Nardos R, Carter-Broo­­ks C, Lowder JL. American Urogynecologic Society best-practice statement: recurrent urinary tract infection in adult women. Female Pelvic Med Reconstr Surg. 2018;24(5):321-335.