WIREDGOV

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.