An Introduction to
Urinary Tract Infection
Content from Promus Direct is written and edited by our team of credentialed medical and scientific professionals to provide current, accurate, evidence-based information.
This article was written by Deitrich Gerlt, M.S. on November 15, 2023. Medically reviewed by staff, M.D. November 2023.
1. What is a urinary tract infection?
Urinary tract infection (or UTI) refers to an infection that occurs within the anatomical regions responsible for producing and removing urine. These regions include the urethra, bladder, ureters, and kidneys. While an infection in any of these locations is correctly referred to as a UTI, other terminology may be used by healthcare professionals to describe the location of infection more precisely. For example, pyelonephritis refers to a more serious infection of one or both kidneys. Cystitis is used interchangeably with bladder infection. Another way to classify UTI is by separating lower urinary tract infections (i.e., urethra, bladder) from upper urinary tract infections (i.e., pyelonephritis).
2. What causes UTI?
UTIs are a commonality in the medical field, although not all UTIs are the same. The most common form of UTI is a bladder infection (cystitis). Most cases of cystitis are preceded by a pathogen from the skin or rectum entering the urethra to infect the urinary tract. This paves the way to the leading risk factor for UTI – female biological sex. That is, due to the short distance between the rectum and urethra, there is increased susceptibility to infection which increases even further with inadequate hygiene. Other risk factors for the development of a UTI include previous UTI, sexual activity, hormonal changes (e.g., menopause, use of spermicides), pregnancy, age (older adults, young children), structural conditions within the urinary tract (e.g., benign prostatic hyperplasia), immunosuppression (e.g., chemotherapy, transplant recipients, certain medications) and poor hygiene (e.g., children potty-training, indwelling catheter).
3. Is my UTI E. coli?
Scientists have documented a wide variety of pathogens involved in UTIs. While many individuals are aware of Escherichia coli (E. coli) many other pathogens are also relatively common. As a broad overview, these pathogens can be separated into bacterial pathogens (e.g., E. coli, Enterobacter, Klebsiella, Proteus, Ureaplasma, etc.) and fungal pathogens (e.g., Candida). Because of the wide variety of pathogens that may lead to UTI, it is not possible to determine which pathogen is the primary concern without additional testing.
4. How do I know if I have a UTI?
If you are experiencing new symptoms or symptoms that you think may be suggestive of a health problem, it is always recommended to seek a thorough medical evaluation by a healthcare professional. All UTIs present slightly different, although most share a few core symptoms depending on the type of UTI. Recall the difference between lower urinary tract infections (cystitis/bladder infection, urethritis) and upper urinary tract infections (i.e., pyelonephritis) as the signs and symptoms are different.
Signs and Symptoms of Lower Urinary Tract Infections (Cystitis/Bladder Infection, Urethritis)
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Suprapubic tenderness (tenderness just above the pubic bone)
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Burning with urination
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Increased frequency of urination
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Discolored urine
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Malodorous urine
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Itching of the genitalia
Signs and Symptoms of Upper Urinary Tract Infections (Pyelonephritis)
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Costovertebral angle tenderness (pain in the mid-back/flank region)
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Hematuria (blood in the urine)
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Fever/chills
5. Are at-home test kits worth it?
The new era of medicine is adopting the widespread availability of direct-to-consumer at-home test kits that allow you to determine if you have any noteworthy pathogens present in the urinary tract. While these test kits often come with a price tag, many are eligible for FSA/HSA payments. When deciding if an at-home test kit is right for you, consider asking yourself the following questions:
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Do I have any classic signs/symptoms of urinary tract infection?
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Do I have any other symptoms that may be due to a urinary tract infection?
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Did my healthcare provider dismiss my symptoms without doing a complete workup?
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Is there a wait time to see my provider?
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Do I trust the lab that my provider is referring me to?
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Am I frustrated taking days off of work just to wait at a doctor's office?
Questions like these are important in determining if the use of at-home test kits is worth it for you. Many customers find it appealing that they can initiate their healthcare from the convenience of their own home without the need for extended waiting room times or booking an appointment at a busy office. With the added convenience of telehealth that some of these direct-to-consumer companies offer, individuals who have symptoms and need treatment can dictate their health outcomes from start to finish on their own time.
6. Which UTI test kit should I order?
It is important to understand the testing modalities that different test kits offer. While some test kits are designed to offer state-of-the-art testing using polymerase chain reaction (PCR), other test kits utilize a dipstick or employ traditional culture methods. PCR offers the highest accuracy of these tests but comes with an increased price tag. Dipstick and culture are cheaper alternatives but may miss certain infections. Dipstick- and culture-based test kits may yield desired outcomes if you are interested in simply knowing whether or not you have a UTI. In contrast, PCR technology provides accuracy and timeliness that many individuals find appealing – particularly the ability to find any pathogens in your urine sample, detect infections where multiple pathogens exist simultaneously, and test for resistance genes that many pathogens carry. Labs that offer PCR services usually have fast turnaround times within 24 hours.
Promus Direct offers an industry-leading UTI test kit (click here for more information) that utilizes PCR technology to assess for 32 different pathogens and 35 different resistance genes. The test kit includes free return shipping once your specimen is collected, and an option to add a telemedicine encounter to the test kit. This test kit also includes a detailed report on pathogens, resistance genes, and recommended antibiotic therapy that aims to eradicate infection effectively and uphold the mission of antimicrobial stewardship. (Click here to learn more about antimicrobial stewardship)
7. Can’t I just take an antibiotic?
Antibiotics are geared towards treating bacterial infections. As mentioned earlier, it is also possible to harbor a fungal infection that results in a UTI. For this reason, it is not always appropriate to take an antibiotic. Another reason to hesitate jumping straight to antibiotic treatment without additional testing is incompatibility and the resulting use of multiple antibiotics.
When providers prescribe antibiotics, the aim is to eradicate infection. The benefits of antibiotics are simple – reduce the number of bad bacteria. However, sometimes the potential cons of antibiotics aren’t discussed in full. These include possible C. difficile infection (which has significant associated morbidity and mortality), ineffectiveness (which costs time and financial burden) if the wrong antibiotic is chosen, and the need for further antibiotic therapy (which may have more serious implications). Implications that may surface with the use of multiple rounds of antibiotics include side effects (e.g., diarrhea, nausea, vomiting, rash, fatigue, etc.) and the development of antimicrobial resistance. Should antimicrobial resistance be an issue, it is reasonable to expect future infections to be more difficult to treat with standard antibiotics. For these reasons a comprehensive laboratory testing experience in those with signs or symptoms of possible UTI becomes desirable.
At Promus Direct, in-depth reporting includes treatment guidance that suggests possible treatment options to providers based on which pathogens are present in addition to any pertinent resistance genes.
8. Will a UTI test kit determine the cause of my symptoms?
Like any laboratory test, no test kit can definitively determine if you have a UTI. In fact, UTI is a clinical diagnosis. Laboratory testing exists as a way to quantify and detail pathogens, resistance genes, and other infectious markers to assist in clinical decision-making and treatment. Our at-home test kits provide a level of detail that larger franchise companies are not capable of providing.