GPAtlas🧭 When to suspect
Lower urinary tract infection (UTI), or cystitis, is an infection of the bladder, usually caused by bowel organisms ascending the urethra – Escherichia coli accounts for the great majority. It is one of the commonest reasons women consult in general practice. The classic triad is dysuria (pain or stinging on passing urine), frequency and suprapubic pain, often with urgency and sometimes visible haematuria.
The central primary-care skill is to diagnose confidently from symptoms, to prescribe – or safely defer – antibiotics with good stewardship, and to recognise the minority who need escalation. The approach differs sharply by age: in women under 65 a symptom-based assessment (supported by selective dipstick testing) guides treatment, whereas in women aged 65 and over the diagnosis is clinical – urine dipsticks are unreliable because asymptomatic bacteriuria is common and rises steeply with age.
| Symptoms or signs (women under 65) | UTI likelihood | Suggested action |
|---|---|---|
| ≥ 2 of: dysuria, new nocturia or cloudy urine | Likely | Treat empirically – dipstick not needed |
| 1 of these three | Possible | Use a urine dipstick to increase certainty |
| None of these three, but other urinary symptoms (frequency, urgency, visible haematuria, suprapubic tenderness) | Uncertain | Use a urine dipstick to guide the decision |
Always exclude the common mimics: vaginal discharge (around three-quarters of women with discharge do not have a UTI), sexually transmitted infection, urethritis, and the genitourinary syndrome of menopause (vaginal atrophy), each of which can cause dysuria.
Source: NICE NG109 · UKHSA Diagnosis of UTI quick reference tools
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