How is Urinary Tract Infection Tested & Diagnosed?
Several conditions could affect the genitalia, and most of these are not necessarily isolated within the genital region. Some may involve the surrounding structures within the lower abdomen, some may affect fertility, and some may even apply various neurological effects that could be fatal if the condition is not managed imperatively.
For example, taking urinary tract infections, one could see how the irony of this situation is screaming at the public for an open discussion. Just like their name suggests, Urinary tract infections are infections that may affect any component of the urinary tract. However, most people believe that UTIs only manifest within the urethra – the part that delivers the urine from the bladder towards the opening of the genitalia. Yes, there might be certain UTIs that manifest in the urethra, but there are also those that may be present in the bladder and even in the kidneys – further showing how education regarding the various conditions affecting the genitalia, as well as the diagnostic tests that can be used to understand the conditions, is essential for everyone, professionals and non-professionals alike.
Several diagnostic tests can be performed to determine whether a patient has a UTI or a different condition that is causing their current manifestations. In UTI, much like in any other condition affecting the genitalia, a proper diagnosis is essential in ensuring that the management strategies being performed are catered towards the correct condition and outcome. While this might seem like it is only concerned about delivering a more effective treatment regimen, it offers a safer therapy that could effectively prevent any untoward damages that would otherwise be prevalent when the patient is not appropriately diagnosed.
Best nationwide walk-in STD testing.
Relatively fast with 1-2 days waiting period
Sample collection is performed on-site to avoid contamination
Kits are fully customizable for your needs
Comprehensive 10-Test Panel available
Save $10 today! Discount applied automatically. No coupon code required.
Best value at-home STD testing kits.
2 day waiting time at the minimum
Samples can be collected in the comfort of your own home for utmost privacy
Sample contamination is possible but avoidable if instructions are followed
Comprehensive kits available for testing other STDs as well
Best for variety of tests in addition to STDs.
3-day waiting time for results
Transactions are performed remotely to maximize the privacy of the patient
Minimal interaction with other people to ensure maximum privacy
Urinary tract infections, as previously mentioned, is an infection of the urinary tract that could affect all four major components of the urinary tract: the kidney, the ureter, the bladder, and the urethra. The urinary tract can be separated into the upper urinary tract and lower urinary tract in some references when defining specific manifestations and the progression of the disease. The lower urinary tract often refers to the urethra and bladder of a patient, while the upper urinary tract often refers to the kidneys due to how high it is located relative to the other parts of the urinary tract.
When testing for UTI, the main thing that physicians would want to know is whether a urinary tract infection is indeed causing the condition of the patient and whether bacteria, viruses, or fungi are causing it. While it is well known that bacterial species, particularly E. coli, commonly cause UTIs, other pathogenic microorganisms may likewise precipitate the same symptoms if they can increase within the patient's urinary tract.
Testing for UTI is not an arduous task, but it is essential in the sense that the diagnostic test being performed is the one that will dictate the direction of the treatment regimen. As previously mentioned, UTI cases do not usually result in severe complications as they are sometimes self-limiting, and sometimes they can be resolved with the help of simple antimicrobials. With the common causative microorganism in most cases being the body’s natural microflora that overgrew due to the favorable conditions, it is no wonder that we do not see several complicated cases of UTI.
However, one should never forget that even though complications are rare, it does not necessarily mean that it does not happen, even when no management strategies are administered to resolve the patient’s manifestations. Although most UTI cases start within the lower urinary tract due to its proximity to the external environment, severe cases where the condition is left untreated may encourage the bacteria to move up towards the upper urinary tract or the kidneys – potentially resulting in a condition known as urosepsis. This essentially happens when the bacteria that s currently colonizing the kidneys migrate to the blood during filtration, causing a systemic infection that could be fatal due to its tendency to cause a drop in blood pressure or shock.
Note that self-medication does not work for this condition, as taking any medication with no tangible proof of the causative agent may only do more harm than good.
In most cases, as soon as you experience specific symptoms within the genitalia, you should get yourself tested immediately. These symptoms may include a painful or burning sensation when urinating, discharge, blood in the urine, cloudy urine, pain in the lower back portion, fever, urine with a strong odor, chills, nausea, and vomiting. While this is not necessarily an exhaustive list, these are some of the symptoms you should look out for, mainly when you are at risk or susceptible to such infections. These risk factors could include poor hygiene, females, pregnancy, non-lubricated condoms and diaphragm, and frequent sexual activity.
The tests commonly performed for UTI cases are different from those administered for sexually transmitted infections in the sense that they are usually less invasive and are only reliant on one standard sample: your urine. The urine is essentially an all-around sample in determining the health of your urinary tract as it can cover everything from the performance of your kidneys to the presence of any pathogens or damages throughout the tract – presenting different parameters through the lab tests that could all be quantified and compared with evidence-based standards to create various diagnoses.
As such, when you are planning to get yourself tested for UTI, one thing that you could expect is that your physician would ask for a sample of your urine to check whether the quality of your urine is up to standard and that your kidneys or any other part of your urinary tract are not failing in its task. Furthermore, your physician may likewise expose you to some imaging tests, especially when they could not identify the cause of a chronic case of UTI. This will allow them to obtain an image of your internal structures that they will then use to conclude whether an underlying damage is causing the symptoms or if the underlying damage itself is the one causing the UTI. This would sometimes mean you would have to undress in some private rooms or be inside a small chamber that would scan your lower torso for any damages. You may also expect that they may ask you to consume or inject you with a contrast that would help them obtain a better visualization of the structures within your urinary tract.
While this is relatively rare, some tests employ a more invasive approach, albeit it is not surgical in any way as they would instead pass through the urethra and up towards the higher sections of your urinary tract. Do note, however, that having a tube inserted within your urethra is relatively uncomfortable, and you should discuss it first with your doctor, especially if you would instead opt for an alternative procedure that would be less invasive but just as accurate.
In total, five different tests are commonly employed for patients with UTI, and each test is performed depending on the results needed by the physician to move forward with their treatment regimen. Each test is highlighted in the table below, and the following would serve as a guide in navigating through the information provided later:
Urinalysis | Urine Culture | Imaging | Cystoscopy | OTC Strip Test | |
Sample Required | Clean Catch Mid-Stream Urine | Clean Catch Mid-Stream Urine | Performed on the patient itself | Performed on the patient itself | Clean Catch Mid-Stream Urine |
Waiting Time | Minutes to hours depending on the facility | At least 48 hours | Immediate | Immediate | Minutes |
Tool Used | Urine Cup Lab Analysis Dipstick Microscope | Urine Cup Lab Analysis | CT-Scan MRI Ultrasound | Cystoscope | OTC Strip |
Indication | Most types | Recurrent UTI (3 or more cases in 12 months, 2 or more cases in 6 months) | Frequent UTI | Frequent UTI | Most types, dependent on patient’s discretion |
To properly recognize the underlying condition behind your manifestations, it is essential to know about the locations where the test is available, as well as the tests that one could request depending on their specific manifestations. While some are more accessible to everyone who would like to be tested to have themselves started on the proper treatment regimen, some are more invasive and would therefore require a prescription or request from their physician as they are the ones who would sometimes perform the test at their clinics. Do note, however, that while accessible tests such as urinalyses can be ordered from an outpatient laboratory that accepts requests for such tests, the treatment plan will still be ultimately determined by your physician. Do not, in any case, attempt to self-medicate as this might exacerbate your condition on top of being a waste of precious resources that could have been utilized for a more refined management strategy.
When looking for the locations where you could get tested for a urinary tract infection, there are three significant places that you could inquire in that would almost always have an available test for you to take. Note that some tests are performed on you by the physician itself and would need your presence in the clinic instead of the conventional sample only.
For tests like urinalyses and urine culture that will be used to determine the composition of your urine and identify the presence of microorganisms within the sample, laboratories would sometimes offer such procedures for outpatients, albeit some would require a prescription from a physician before they approve the request. In most cases, these laboratories would request a sample of your urine with a urine cup that you would then have to fill with a midstream clean-catch urine to avoid any contamination of the sample. The waiting time for such could span from a few minutes to days, depending on the test requested and the efficiency of the selected laboratory itself. Some laboratories may be located independently from a hospital, but some are present within the hospital itself, mainly catering to patients admitted within the facility.
Other tests administered for UTI diagnosis are either more invasive than the previous two mentioned or would need a particular type of instrument that could only be utilized within the hospital's premises. In this case, you would have to go to your doctor’s clinic personally, and they are the ones who would request the test itself, especially when you are experiencing recurrent UTI cases. Some would employ various imaging techniques such as an MRI or a CT-Scan that requires large machineries to create an accurate visualization of the structures of your urinary tract itself. Some tests like a cystoscopy would insert a thin tube in your urethra – meaning that your doctor would perform the test on you when your doctor suspects that your tract needs a closer look.
While over-the-counter, at-home dipsticks are not as accurate as the other tests that have been mentioned beforehand, there are available urine strips in your local pharmacies that could provide you with some information regarding the contents of your urine. These tests are not as reliable as the rest as this is subject to a wide array of inconsistencies and contamination and a subjective interpretation of the results – making it unreliable as a diagnostic tool for a potential urinary tract infection. However, do note that this can still be used as a preliminary diagnostic method so that you would have some cue as to when you would have to visit your physician for a thorough examination.
To understand what specific tests are available for UTI, the following outline highlights the various information regarding each type of test, covering everything from the procedure itself to the costs associated with the test.
A urinalysis is an analysis performed on a urine sample that is often utilized as either a screening tool, a diagnosis tool, or a monitoring tool – all of which are used to ensure that the treatment plan is tailored towards their needs and presentation. A urinalysis would often include the following parameters:
There are two variations to the test, and this usually refers to the sample collection process that your physician has requested.
For a 24-hour collection test, this would entail that when you wake up, you would first have to urinate without collecting any sample first. You would then have to collect all your urine in the provided container throughout that day. The next day, upon waking up, you would again have to collect that urine sample as the last input within the container for those 24 hours. You would then be advised to store the sample in the refrigerator or a cool place while still collecting more samples.
However, for a one-time collection test, you would usually be asked for a sample in the morning when your urine is concentrated. The sample collection is performed using the clean catch method, which is how it is usually performed.
Once the sample is provided to the laboratory for both of these tests, you then resume your daily activities as you wait for the result to arrive.
Test analysis may span from minutes to hours, depending on the facility’s efficiency.
A urinalysis would require a sample of your urine, but it is usually necessary to be a clean catch mid-stream urine sample to prevent any contamination. The process of collecting the sample has been described in the section above.
Most urinalysis tests would be priced at around $30 to $250, depending on the facility where you are tested and the scope of the test itself. However, out-of-pocket payment for urinalyses is not that common, as most insurance companies cover the test in their policy.
In most cases, urinalysis results are considered accurate enough to determine several points that could help a physician provide a more conclusive diagnosis as to what is causing your present condition. However, there are still cases wherein a urinalysis test is insufficient to give a solid diagnosis, especially when it involves certain damages to the urinary tract structure itself. To achieve an accurate representation of the urine’s composition, a laboratory must employ proper practices that would ensure that the quantification of parameters is accurate and devoid of any potential contaminants, albeit the patient is partly responsible for the issue of contamination as well.
A patient will usually be asked to provide a small urine sample for a urine culture. This urine sample will be collected using the clean catch method – similar to how it was collected during urinalysis. This would entail cleaning the urethral opening with a sterile wipe, urinating first into the toilet, then collecting the mid-stream sample using the collection container. It is recommended that the container must not come into contact with any part of the skin to avoid contaminating the sample.
Following the collection process, the sample will then be placed in agar plates incubated at body temperature. The sample will then be grown for around 24 to 48 hours and then examined by a laboratory technician to determine the type of microorganisms that have grown, their size, the color, shape, and identity of the colonies that have grown from the urine sample. In some cases, the technician might perform a test known as gram staining to aid the pathogenic species' determination further. Susceptibility testing may also be performed to determine which antibiotic will best work against the pathogenic microorganism in the patient’s urine sample.
In most cases, a sample with cultures that are greater than 100,000 colony forming units (CFU) in quantity would indicate an underlying infection. However, 1000 to 100,000 CFUs, in cases where not enough bacteria are present in the sample yet, could still be characterized as an infection, especially if symptoms are present. The presence of organisms such as Lactobacillus or other non-pathogenic species may indicate contamination.
It usually takes 24-48 hours before the results can be released, as the microorganisms still have to be grown.
A urine culture would likewise require a clean catch mid-stream urine sample collected using the same sample collection process described in the urinalysis section. Utmost care is even more advised as any contamination could lead to inconclusive results.
A urine culture test would often be priced at around $80, depending on the extent of the tests and the facility's prices where you performed the analysis. A urine culture is usually ordered alongside a urinalysis, and some insurance companies offer coverage for this test, especially private insurance policies.
A urine culture is relatively accurate as it can determine the actual presence of microorganisms within your urine sample. However, due to sample contamination, multiple pathogenic species may grow within the agar plates – making it possible to have an inconclusive result if the sample is not collected correctly.
A CT Scan that is performed on the urinary tract is commonly known as a CT Urogram – a procedure done to visualize the urinary tract structures with the help of imaging techniques and a contrast dye. The process of a CT Urogram is as follows:
On the one hand, an MRI is a test that is used to visualize soft tissues specifically in detail – providing significant distinctions, mainly when there are masses involved within the urinary tract. The procedure of an MRI is similar to a CT Scan, albeit it does involve a different machine with a tunnel-like tube that the patient must lie in completely still while being scanned. An IV line is also placed in cases where a gadolinium contrast is necessary for better visualization.
A CT scan usually takes around 90 minutes to complete, while an MRI would take 2 to 15 minutes for each image captured.
No samples are required as the test is performed on the patient itself.
An MRI would usually cost around $1,692 on average for an abdominal scan with contrast, while a CT Scan would range from $500 to $1500 depending on the location of your testing center. Insurance policies usually cover both tests if the test is deemed medically necessary by the agency.
Imaging techniques such as a CT scan or MRI are highly reliable and accurate as it shows, in real-time, the internal structures of the body without relying on inferences from other laboratory parameters. However, considering that the images are still subject to interpretation, the accuracy could still be severely crippled by the physician's performance, albeit it rarely happens as they are professionals who are well-versed with these procedures.
Two types of cystoscopy procedures can be administered to a patient: a rigid type where the tube does not bend so that the physician can pass instruments through the tube to perform biopsies and remove tumors, and a flexible type which uses a bendable scope that is aimed at examining the bladder and urethra for any problems.
For a rigid type cystoscopy, your physician will insert a lubricated cystoscope within your urethra, moving forward towards your bladder. They may then insert several instruments that they might need to obtain tissue samples from suspicious growths within your urinary tract. On the one hand, during a flexible type cystoscopy, your physician may inject sterile saltwater into your bladder through the cystoscope to stretch and fill the bladder. This allows your physician to make it easier the bladder lining.
Once done, your physician will then drain the injected liquid in your bladder by asking you to urinate in the restroom. After a cystoscopy, you may experience some belly pain, blood in the urine, or painful urination a day or two following the procedure. Antibiotics may also be prescribed as a prophylactic measure to avoid any infection due to the process.
The result is obtained instantaneously as the images are obtained in real-time instead of relying on the image to develop after a few minutes.
No sample is collected as the procedure is performed on the patient itself.
A cystoscopy may range from $350 to $3000 depending on the chosen facility and where the test itself was performed. However, note that this procedure is commonly covered by insurance policies, especially when the process is medically necessary.
Considering that the test visualizes the urinary tract structures in real-time, the results of the test are relatively accurate and reliable, subject, of course, to the interpretation of the professional handling your diagnosis.
According to several references and sources, the following table outlines the average costs of each procedure identified, as well as its qualification under most insurance policies available in the US:
Urinalysis | Urine Culture | Imaging | Cystoscopy | OTC Strip Test | |
Average Cost | $30 to $250 | $80 | MRI: $1,692 CT Scan: $500 to $1500 | $350 to $3000 | Around $5.26 per strip |
Covered by Insurance? | Yes (for most insurance policies) | Yes (for most private insurance policies) | Yes (if medically necessary) | Yes (if medically necessary) | No |
It is usually prescribed when the physician wants to obtain a deeper insight into what antibiotic will be most effective for the pathogenic species that have been identified.
UTI symptoms usually resolve around 24 to 48 hours after the treatment begins, but one must still finish their treatment to eliminate the pathogenic microorganism in the patient’s system.
It may cause a systemic infection as it reaches the kidney – causing a condition known as urosepsis.
It is usually preferred to diagnose potential cases of kidney and bladder stones, kidney masses, UTIs, trauma, and obstructions.
An MRI does not work very well in the urinary tract, especially when there is no dye administered.
Testing.Com
Medicina
Centers for Disease Control and Prevention
Written by Mark Riegel, MD
Help stop the spread of STDs by knowing your status. Get tested today!