UTI Myths

Often we acquire facts about UTIs, or we are told UTI information and management tips from people and professionals we trust, that are inaccurate or simply untrue. Here we debunk some of the most common UTI myths we come across.
UTI Myth 1: Urinary dipsticks and MSU cultures are a reliable way to diagnose a UTI

FALSE

Urinary dipsticks used by doctors as a first-line diagnostic tool have been widely discredited with research showing they miss up to 70% of infections.1, 2, 3  Research also shows that the fundamentally flawed MSU culture test misses 50–80% of UTIs 3, 4

If you feel as though you have a UTI but your tests come back negative, talk to your doctor about the proven inadequacies of gold standard UTI tests.  Ask your doctor to read this 2019 research paper before dismissing your symptoms, ‘Reassessment of routine midstream culture in diagnosis of urinary tract infection’.

References

1 Khasriya R, Khan S, Lunawat R, Bishara S, Bignal J, Malone-Lee M, et al. The Inadequacy of Urinary Dipstick and Microscopy as Surrogate Markers of Urinary Tract Infection in Urological Outpatients With Lower Urinary Tract Symptoms Without Acute Frequency and Dysuria. JUrol. 2010;183(5):1843-7. www.ncbi.nlm.nih.gov/pubmed/20303096

2 Kupelian AS, Horsley H, Khasriya R, Amussah RT, Badiani R, Courtney AM, et al. Discrediting microscopic pyuria and leucocyte esterase as diagnostic surrogates for infection in patients with lower urinary tract symptoms: results from a clinical and laboratory evaluation. BJU Int. 2013;112(2):231-8. doi: 10.1111/j.1464-410X.2012.11694.x. PubMed PMID: 23305196. www.ncbi.nlm.nih.gov/pubmed/23305196

3 Brubaker L, Wolfe AJ. The Female Urinary Microbiota/Microbiome: Clinical and Research Implications. Rambam Maimonides medical journal. 2017;8(2). Epub 2017/05/04. doi: 10.5041/rmmj.10292. PubMed PMID: 28467757; PubMed Central PMCID: PMCPMC5415361. www.ncbi.nlm.nih.gov/pubmed/28467757

4 Gill K, Kang R, Sathiananthamoorthy S, Khasriya R, Malone-Lee, J. A blinded observational cohort study of the microbiological ecology associated with pyuria and overactive bladder symptoms. Int Urogynecol J. 2018. Epub 2018/02/20. doi: 1007/s00192-018-3558-x. PubMed PMID: 29455238. www.ncbi.nlm.nih.gov/pubmed/29455238

UTI Myth 2: A 3-5 day course of antibiotics is always enough to treat a UTI, even if you have lingering UTI symptoms after your treatment is complete

FALSE

An estimated 25-35 percent of people treated according to current clinical guidelines for UTI fail to respond to treatment.1, 2   If you have finished your course of treatment and you feel your infection has not fully gone, and you still have white blood cells showing in your urine sample, there is a good chance you are right.  Go back to your doctor and talk to them about the known failure rate of UTI treatment.

References

1 Cited in Malone-Lee J, Urinary infections are complex and hard to treat, BMJ 2017;359:j4784 https://www.bmj.com/content/359/bmj.j5766.full?ijkey=IiTCSBtWau0sm9j&keytype=ref

2 Zalmanovici TA, Green H, Paul M, Yaphe J, Leibovici L. Antimicrobial agents for treating uncomplicated urinary tract infection in women. CochraneDatabaseSystRev. 2010;(10):CD007182

UTI Myth 3: Recurrent UTIs are new infections caused by introducing new bacteria into the bladder through acts like poor personal hygiene (ie wiping back to front), sexual intercourse, not drinking enough water, tight clothing, underwear made form synthetic fabrics etc.

FALSE

There is no clinical evidence supporting the long-held belief that recurrent UTIs are caused by the introduction of new bacteria due to poor personal hygiene, sexual intercourse, inadequate fluids, tight clothing or wearing synthetic underwear.  However, researchers have shown that bacteria (such as E. coli) can invade the cells that line the bladder very early on in an acute UTI, forming biofilm-like intracellular bacterial communities.  The bacteria are able to communicate between themselves via a process known as ‘quorum sensing’ and act as a bacterial reservoir capable of seeding future acute attacks and/or ongoing lower urinary tract symptoms. 1

If you are sick and tired of being told you are responsible for your recurrent UTIs, tell your doctor what you have learned about bacteria becoming embedded in the bladder lining where they go on to cause recurrent acute UTI attacks or ongoing UTI symptoms.  Direct your doctor to this Chronic UTI picture commentary by Emeritus Professor James Malone-Lee.

References

1 Opal SM, Communal Living by Bacteria and the Pathogenesis of Urinary Tract Infections. PLoS Med. 2007 Dec; 4(12): e349. Published online 2007 Dec 18; doi: 10.1371/journal. pmed.0040349 www.ncbi.nlm.nih.gov/pmc/articles/PMC2140084/