Health

Here's Why You Can Test Negative For A UTI & Still Have Symptoms

Plus, what you definitely *shouldn’t* do until you have a diagnosis.

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Over half of people with vaginas will get a urinary tract infection (UTI) at some point in their lives, but even more experience symptoms of one. Sometimes, people will have all the telltale signs of a UTI — a constant urge to pee even when nothing's in there, burning while peeing, bladder pain — but their urine cultures will come up negative. Does this mean you have a UTI that's just not showing up on tests, or does it point toward a different health issue? It turns out those are both possibilities.

Why does it matter, you ask? Well, it affects how you should go about treating it. Dr. Dana Rice, M.D., board-certified urologist and creator of the UTI Tracker app, cautions against taking antibiotics if you have no confirmed UTI, even if you have symptoms. "In a world with increasing significant multi-drug resistant (MDR) bacteria, I am not a fan of antibiotics without culture positive results," she tells Bustle. "I think that part of the increase in MDR organisms is the overuse of antibiotics for urinary symptoms that feel like a classic UTI but are not truly infectious in nature." In addition, there are healthy bacteria in your bladder that you don't want to eliminate if you can avoid it, she says.

How do you know if you actually have a UTI or something else, though? And what else could it be? Here are a few things UTI symptoms with negative test results could point toward — and what steps you and your doctor might need to take next.

1
A UTI That The Test Isn't Detecting

One possibility is that you really do have a UTI that's flying under the radar. One 2017 study in Clinical Microbiology and Infection found that one in five women with UTI symptoms had negative results on the standard tests, but almost all these women had UTIs according to the more sensitive quantitative polymerase chain reaction (qPCR) test.

"Standard urine cultures test for specific types of bacteria, but many women will have infections that are not able to be grown in these cultures," Rice says. "Another possible reason for a false negative test (no bacteria grown) is that often, the test requires a certain number of bacteria to be grown in culture. For instance, if someone has just urinated prior to leaving a sample and there is not a sufficient quantity of urine built up in the next voided sample, it is possible for a standard urine culture to report negative findings." A false negative can also occur if you've already taken antibiotics, so make sure not to do that.

If you think you might have a UTI that's not being detected, your doctor may be able to do a PCR laboratory test, Rice says. Dr. Jennifer Linehan, M.D, urologist and associate professor of urology and urologic oncology at the John Wayne Cancer Institute at Providence Saint John’s Health Center in Santa Monica, tells Bustle that another type of test called Next-Generation Sequencing (NGS) is even more accurate.

Even then, it may not always be clear what your results mean. Not all bacteria are problematic; some are healthy bacteria that get into the sample from the vagina, and others are just part of the urinary microbiome. So, the presence of bacteria doesn't necessarily mean you have a UTI.

2
Your Uretha Is Irritated After Having Sex

"I have many patients with urethritis after intercourse who believe they have UTIs, but when I culture before and after, the cultures are negative," Rice says. People sometimes even call the UTI-like symptoms you can get from intercourse "honeymoon cystitis." If this is what you're dealing with, the symptoms should go away within a few days without antibiotics. "Often, if I prescribe natural supplements and bladder pain relief medications, the symptoms are limited to less than 24 hours," Rice says. You should still consult your doctor, but don't be surprised if they advise pain relief rather than antibiotics.

3
Interstitial Cystitis

Interstitial cystitis (IC) is a chronic bladder condition that mimics many of the symptoms of UTIs — bladder and/or urethra irritation, frequent urination, and a constant feeling like you have to pee — but the causes are different for different patients. Some have visible damage to the bladder lining that appears to be causing the discomfort, but others don't.

"There are many working theories including an autoimmune component, chronic inflammation, and even neurologic causes, but currently there is no one hallmark cause and effect for this diagnosis," Rice says. She adds that generally, it's diagnosed by exclusion, meaning everything else it could be has been ruled out. Interstitial cystitis has a number of treatments, including dietary changes, medications, and procedures like bladder instillations.

4
An STI

Some STIs like gonorrhea and chlamydia cause symptoms like frequent urination and bladder pain that can be confused with a UTI, family medicine doctor Dr. Sheryl Recinos, M.D., tells Bustle. You should be able to rule these out or in pretty easily by getting an RNA-based test, she says.

5
Bladder Hypersensitivity

Some people develop UTI-like symptoms in response to irritants, like caffeine, spicy foods, and citrus foods, because their bladders are hypersensitive, Linehan says. You can test for bladder hypersensitivity with a urodynamics test, where the bladder is filled with a very small amount of fluid. "If the patient reports that they have to urinate when only a small amount is in the bladder, that is hypersensitivity," Linehan says. Often, this problem will go away through dietary changes you work out with your doctor.

6
Pelvic Floor Dysfunction

Pelvic floor dysfunction is improper positioning of your pelvic floor muscles, which surround your bladder, bowels, and reproductive organs. If the muscles around your bladder are too tight, this can lead to bladder or urethral pain and/or frequent urination.

Sometimes, the dysfunction comes from having had a UTI in the past, Stephanie Prendergast, CEO and co-founder of the Pelvic Health and Rehabilitation Center, tells Bustle. "A UTI is a painful visceral experience which causes pelvic floor muscle tightening in response to the pain," she says. "Sometimes the muscles do not relax after the UTI is treated with antibiotics, especially if the person has had a number of infections in a short period of time." You can see a pelvic floor physical therapist to get evaluated and treated for pelvic floor dysfunction.

If UTIs go untreated, they'll often clear out on their own, but sometimes, they can make their way up to the kidneys, and a kidney infection requires immediate attention, Linehan says. If you begin to experience signs of a kidney infection, like blood in your urine, fever, or back pain, talk to your doctor right away.

Experts:

Dr. Jennifer Linehan, M.D.

Dr. Sheryl Recinos, M.D

Dr. Dana Rice, M.D.

Studies cited:

Faubion, S. S., Shuster, L. T., & Bharucha, A. E. (2012). Recognition and management of nonrelaxing pelvic floor dysfunction. Mayo Clinic proceedings, 87(2), 187–193. https://doi.org/10.1016/j.mayocp.2011.09.004

Gasiorek, M., Hsieh, M. H., & Forster, C. S. (2019). Utility of DNA Next-Generation Sequencing and Expanded Quantitative Urine Culture in Diagnosis and Management of Chronic or Persistent Lower Urinary Tract Symptoms. Journal of clinical microbiology, 58(1), e00204-19. https://doi.org/10.1128/JCM.00204-19

Heytens, S., De Sutter, A., Coorevits, L., Cools, P., Boelens, J., Van Simaey, L., Christiaens, T., Vaneechoutte, M., & Claeys, G. (2017). Women with symptoms of a urinary tract infection but a negative urine culture: PCR-based quantification of Escherichia coli suggests infection in most cases. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, 23(9), 647–652. https://doi.org/10.1016/j.cmi.2017.04.004