Health professionals should diagnose women under 65 with a
urinary tract infection (UTI) if they have two or more key
urinary symptoms according to a new quality standard published by
NICE today (15 February 2023).
Diagnosis of a UTI in women under 65 can be made with increased
likelihood when two or more key urinary symptoms are present,
although no single symptom or combination of symptoms is
completely reliable. Women who present with two or more key
symptoms should not require a dipstick test.
Professionals should exclude any other causes of urinary symptoms
and consider warning signs of other conditions such as sepsis and
cancer when diagnosing a UTI.
The new quality standard includes five statements and replaces an
earlier quality standard published in 2015. They are:
- Women aged under 65 years are diagnosed with a UTI if they
have 2 or more key urinary symptoms and no other excluding causes
or warning signs.
- Adults with indwelling urinary catheters do not have dipstick
testing to diagnose UTIs.
- Men and non-pregnant women are not prescribed antibiotics to
treat asymptomatic bacteriuria.
- Non-pregnant women with an uncomplicated lower UTI are
prescribed a 3-day course of antibiotics, and men and pregnant
women with an uncomplicated lower UTI are prescribed a 7‑day
course of antibiotics.
- Men with a recurrent UTI, and women with a recurrent lower
UTI where the cause is unknown or a recurrent upper UTI are
referred for specialist advice
Women have a shorter urethra than men. This means that bacteria
are more likely to reach the bladder or kidneys and cause an
infection. The management of urinary tract infection in trans
people will need to take account of any gender reassignment
surgery and whether there has been structural alteration of the
person’s urethra.
Dr Paul Chrisp, director of Centre for Guidelines at NICE
said: “UTIs are a common occurrence, but they can
cause people a great amount of discomfort and pain. For people
with recurrent UTIs this can lead to a reduction in their quality
of life.
“This quality standard sets out useful and usable guidance for
health professionals to improve the diagnosis and management of
UTIs in both women and men while also setting a clear treatment
pathway for people with a recurrent UTI who are at higher risk of
complications.
“The standard will also help ensure that people are not
misdiagnosed. By setting out clear methods for the diagnosis of
UTIs, it will help limit the prescription of unnecessary
antibiotics which may increase anti-microbial resistance to
certain treatments.”
The new quality standard also says the prevalence and frequency
of UTI’s should be measured accordingly:
- The number of episodes of a suspected UTI should be recorded
in the patient’s records.
- Recurrent UTIs should be recorded in the patient’s records.
