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Standard urine test for cystitis is questioned

Women who consult their GP with symptoms of an uncomplicated urinary tract infection (UTI) can probably be treated without the need for a traditional urine test, say researchers in Clinical Biology and Infection. Their study found that nearly all women reporting cystitis symptoms did have a bacterial infection even when nothing was detected with traditional urine testing. UTI symptoms, such as pain when urinating or needing to urinate often or urgently, represent 2-5% of the reasons why women see their GP. Diagnosis is generally based on clinical signs and urine dipstick testing for leucocyte esterase and nitrate. In around a quarter of cases urine tests are negative, however, so doctors may assume that no bacterial infection exists and may send these women home without antibiotic treatment. The new study included 220 Belgian women who had visited their GP with UTI symptoms, as well as 88 healthy volunteers. All of the women gave urine samples, which were tested in the standard way and with a highly sensitive quantitative polymerase chain reaction (qPCR) test. Among the women with UTI symptoms, standard testing detected bacteria in 80.9% of urine samples. The sensitive qPCR test found evidence of Escherichia coli in 95.9% of samples and Staphylococcus saprophyticus in 8.6%. Overall, the qPCR test found evidence of an infection in 98.2% of women with UTI symptoms. In the women without symptoms, standard testing picked up E coli in 10.5% of samples and qPCR picked up E coli in 11.6%. The authors concluded, “Instead of spending time and energy to prove an uncomplicated UTI, physicians can rely on the typical symptoms and focus on acknowledging and managing the patient’s complaints.” Stefan Heytens, study author, who is a practising GP and a researcher at the department of family medicine and primary healthcare at the University of Ghent, Belgium, said, “We found E coli in nearly all women complaining of symptoms, even if they had a negative traditional urine culture. This suggests that, if a woman has these symptoms, she probably does have a UTI.” He added, “Our findings support previous research which indicates that traditional testing may not be helpful in uncomplicated UTIs. However, traditional urine culture tests may still have a role to play if treatment fails or if there are signs and symptoms of a more complicated UTI.” Heytens and colleagues said that the findings need to be confirmed in further research. They also plan to investigate whether women with UTI symptoms but also a negative urine test would benefit from treatment with antibiotics.