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After three Urinary Tract Infections (UTIs) in less than three years, Fiona Rose was only too familiar with the painful symptoms.

‘I felt as though I was being cut inside whenever I went to the loo,’ says Fiona, 24, a customer data analyst from Yeovil, Somerset.

Each time, Fiona would go to her GP who having listened to her symptoms, would prescribe antibiotics, and within days she would recover.

However, when, in November 2015, she felt the symptoms once again, her experience was very different.

‘I’d just moved to Bristol to start a new job and had joined a new GP practice,’ she recalls.

Rather than rely on her description of her symptoms to diagnose a UTI, her new GP gave her a urine ‘dipstick’ test where a specially treated plastic strip is exposed to drops of urine to check for the presence of an enzyme, leukocyte esterase, which provides evidence of a bacterial infection.

Fiona’s test came back as negative, and rather than prescribe antibiotics, the GP questioned whether Fiona might just be stressed.

‘They asked me if I was having problems at work or if my relationship with my boyfriend, James, was on the rocks,’ Fiona says.

She had to go home and put up with her pain, but the symptoms only worsened.

In six months, Fiona returned to her surgery five times each time she saw a different GP who did another urine test, and each time the result was negative.

‘By then my urinary tract felt raw and I couldn’t sleep at night,’ says Fiona. ‘I was throwing up several times a day, and my stomach was swollen with the inflammation in my bladder.’

But because of the test results, her GPs refused to believe she had a UTI.

What she didn’t know was that the validity of these tests had been under scrutiny for years.

There are two standard tests given by GPs to women who have a suspected UTI. One is the dipstick test Fiona had, the other involves the urine sample being sent to a laboratory for testing.
Yet since the early Nineties, various studies have shown that a substantial number of women with a UTI will be found to have no evidence of a bacterial infection.

A new study has highlighted the scale of the problem.
Published in April in the journal Clinical Microbiology and Infection, it found that while one in five of 220 women with UTI symptoms, such as burning pain on urination and the need to urinate frequently, had a negative result from a standard urine test, almost every woman in the group (98 percent) was diagnosed with a bacterial infection when the samples were subjected to a more advanced technique.

Known as quantitative PCR (polymerase chain reaction), it’s designed to spot tiny quantities of bacterial DNA. The test, however, is not widely available and is currently used only for research.

‘The message for doctors is that if a woman has typical urinary symptoms, she has a UTI. There is nothing more to explore,’ says lead researcher Dr Stefan Heytens of the Department of Family Medicine at the University of Ghent in Belgium.

Around four million British women develop a UTI every year, most frequently cystitis, an infection of the bladder. Women are more at risk because they have a shorter urethra and so there is a shorter distance for bacteria to travel to reach the bladder.

UTI symptoms account for one in 20 women’s GP appointments and a significant proportion of the 65 million urine specimens collected every year in the NHS.

Patients with mild to moderate symptoms are sometimes advised to take ibuprofen and let the infection get better on its own. Doctors can also prescribe an antibiotic without testing.