25 to 50 per cent
of whom will
experience
multiple recurrent
episodes.
An estimated 20 to
40 per cent will
experience more
than one episode
Approximately 60
per cent of women
will experience an
acute UTI in their
lifetime
THE NEW GUIDELINES
rUTI: Two separate
culture-proven UTIs
within six months or
three episodes
within one year.
UTIs are one of the most common reasons women see a urologist, said Dr. Lynn Stothers. Many other conditions can mimic it, or other risk factors can co-mingle with UTIs to complicate matters further. This notoriously common infection is surprisingly hard to pin down.
A relatively new guideline was designed to address current concerns with overdiagnosing, underdiagnosing, improved testing, treatment and prevention of acute, uncomplicated (no known risk factors), recurrent UTIs in women.
Dr. Stothers, professor of urology at UBC and a board member for the American Urologic Association and the Urology Care Foundation, helped write the guideline in 2019.
“And what that guideline talks about is the concern about antibiotic use and chronic antibiotic use in women to have these kinds of [acute, recurrent UTI] symptoms,” she said.
“You'll see in the guideline that one of the main foundational principles is actually the diagnosis because there are a lot of conditions that mimic UTI that are not bacterial UTI.”
​
Stothers says there are two ways doctors look for UTI. One is the traditional way, with a dipstick or a microscopic exam, where the urine sample is assessed visually.
Then there’s the culture, which is the more thorough and accurate choice. Labs will identify the specific bacteria, grow it and test its susceptibility against antibiotics. The challenge is, it can take up to 72 hours to come back, whereas the first option presents immediate results.
​
If you’ve ever had a UTI before - you’ll know, three days feels like an eternity.
In some provinces, the first few infections might be diagnosed with the dipstick test or a microscopic exam. But, after a few infections, or if a woman has experienced two or more UTIs within six months, a urine culture is required to prove a diagnosis.
This, again, helps to avoid misdiagnosing and mistreating the infection.
To address the 72-hour burning-crotch, constant-need-to-pee symptoms while the culture is being evaluated, the guidelines recommend treating with UTI antibiotics, with a plan to follow up after the results are in.
​
These results will inform whether the patient should continue the prescription and what the next course of action should be.
“You leave your urine for culture, then you swallow your antibiotics, you start taking them if you think it's an acute UTI, and then you get your proof,” said Dr. Stothers.
​
Because testing and treatment vary regionally, guidelines like these are essential. And she’s proud of what they’ve come up with.
Which costs several billion dollars globally per
year, reaching approximately $2 billion per year
in the United States alone.
“There are lots of really exciting things in the field of research regarding recurring UTI. This is a really interesting time to be involved in clinical care because there are lots of things on the horizon that are being evaluated.”
“Ensuring that women don't have an alternative diagnosis, appropriate use of cultures to document bacteria, and the resistance pattern,” she said. “I'm really proud of that document. it's a great step forward.”
