UTI diagnoses should be given to women with two out of three key symptoms

Health professionals in primary care should diagnose women under 65 with a urinary tract infection (UTI) if they have two or more of three key symptoms – dysuria, nocturia and cloudy urine – an update to NICE guidelines suggests.

The guidelines are aimed at producing more accurate diagnoses, and to reduce unnecessary prescriptions of antibiotics, which is accompanied by a higher risk of antimicrobial resistance.

The new guidance suggests that ‘no single symptom or combination of symptoms is completely reliable in diagnosing UTI’, advising instead that ‘diagnosis of a UTI in women under 65 can be made with an increased likelihood when two or more key urinary symptoms are present’. However, other causes or warning signs must be first excluded.

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Dr Paul Chrisp, director of the 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.

‘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.’

Service providers, such as pharmacies and GP practices, should ensure that procedures are in place to assess and document the signs and symptoms of women aged under 65 presenting with a suspected UTI, the guidance states.

Contractors should ensure that their pharmacists have access to information on the key urinary symptoms and how to exclude other causes and warning signs, including:

• asking about vaginal discharge and irritation and other possible urethral causes of urinary symptoms to exclude vaginal and urethral causes;
• using the presence of 2 or more key urinary symptoms to diagnose a likely UTI and guide treatment;
• checking for signs and symptoms of sepsis, pyelonephritis and cancer in case urgent action is needed to address these.

The key symptoms suggested by the guidelines are: dysuria (burning pain when passing urine), a new occurrence of nocturia (passing urine more often than usual at night), and cloudy urine.

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Dr Chrisp said that ‘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’.

In addition to providing new guidance on diagnosis, NICE has also published specific guidance on the prescribing of antibiotics for patients with a UTI.

The new guidance recommends that ‘men and non-pregnant women are not prescribed antibiotics to treat asymptomatic bacteriuria’ and that 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.

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NICE also suggests that 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.

A version of this article first appeared on our sister title Nursing in Practice.