When You Have All the Symptoms but Your UTI Test Is Negative

2 min read

Urine test

If you’re prone to UTIs, then you know all the telltale signs: burning when you pee, needing to go nonstop, barely squeezing out any urine when you do. So if you get a urine culture at the doctor and it comes back negative, it can be confusing and frustrating. You’re experiencing all the usual symptoms, what’s the deal? Is your body deceiving you? Chances are, it’s not. The test might be wrong.

Get this: Studies show a standard urine culture is only accurate about half of the time, and a rapid strip test is accurate just 30% of the time. Many doctors don't bother with these tests since they're so unreliable. Instead, doctors will often prescribe antibiotics based on your medical history and symptoms.

Why are urine tests unreliable?

There are multiple reasons urine cultures can fail to detect an active UTI. For one, the role of white blood cells in testing is complicated and often misunderstood. To be considered positive, your urine test needs to show a certain level of white blood cells. But according to research, the standard clinical level is too high. If your urine contains white blood cells at all, then you probably have a UTI. So if you test below this threshold, your infection may go undetected.

In addition, urine tests aren't able to grow most of the bacteria types that are in the bladder, so the results they give can be extremely limited. And if a test detects multiple pathogens, it’s typically considered a contaminated sample and thrown out. However, multiple pathogens could be causing a UTI!

The Kass threshold is an important part of UTI testing too. It's named after a scientist who correlated certain amounts of bacteria with kidney infections. Note: kidney infections, not UTIs. Even though they’re two different things, the medical community began using the Kass threshold as the standard method for detecting UTIs. Never mind that a person can have a UTI with a smaller amount of bacteria than what indicates a kidney infection.

Are there better testing methods for UTIs?

The good news is that more reliable options for UTI testing do exist. They're not always easy to execute, and it helps to have a doctor who understands the need for different testing methods and can accurately interpret the results.

One example is simply modifying a standard urine culture test to account for a wider range of results. For example, a doctor might increase the pathogen incubation period or decrease the threshold for colony-forming units. Another test is the fresh sample urine microscopy. It looks for white and red blood cells, epithelial cells, fungi, bacteria and other things that might indicate a UTI is present.

Can you have UTI symptoms without a UTI?

Of course, if you test negative for a UTI and are still experiencing symptoms, there’s always a possibility that another health condition is to blame, like overactive bladder, interstitial cystitis, STIs, ovarian cysts, yeast infections, or bladder prolapse. So if your test says “nope” to the UTI, be sure to talk to your doctor about other potential causes.

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