Most people are familiar with common urinary tract infection (UTI) symptoms, such as frequent urination, burning, or cloudy urine. In some cases, elevated levels of bacteria in the bladder can produce similar symptoms without an actual bladder infection developing. This is why confirming a UTI diagnosis with a urine culture before beginning antibiotic treatment is important.
While both tests involve providing a urine sample, a urinalysis and a urine culture serve different purposes, and only one can accurately diagnose a UTI.
A urinalysis, often performed with a chemical dipstick test, offers a quick overview of certain properties of urine, including blood, pH, and white blood cell count. It is commonly used as an initial step by your doctor when UTI symptoms are reported.
However, a urinalysis cannot confirm whether a true infection is present. It does not identify specific bacteria or assess whether bacterial levels are high enough to indicate infection or UTI risk, regardless of your symptoms.
It is normal for urine to contain small amounts of bacteria that do not cause harm, a state known as colonization. Because of this, healthcare providers should not base antibiotic treatment decisions on urinalysis results alone.
A urine culture is a laboratory test that determines whether a bacterium or other organisms are present in the urine and whether they are multiplying to a degree that causes infection. It is considered the gold standard for confirming a true UTI diagnosis and can take up to 72 hours for results to return from the lab.
This means there is significant bacterial growth, confirming the presence of a urinary tract infection. It also identifies which bacteria are responsible, allowing healthcare providers to select the most appropriate antibiotic treatment. Not all antibiotics treat all bacteria, so accurately matching the treatment is critical, especially to avoid a recurrent UTI.
This indicates that no infection is present. In these cases, antibiotics are not recommended, as they would not address the symptoms and could contribute to the growing problem of antibiotic resistance. If a patient has UTI-like symptoms but a negative culture, symptom management is recommended.
Options may include bladder pain relief products (such as over-the-counter pyridium) and lifestyle modifications to support bladder health. Persistent negative cultures may point to other underlying conditions, such as interstitial cystitis or painful bladder syndrome, which require different treatment approaches.
As urologist Dr. Nazia Bandukwala notes: “Without a culture, I stress to the patient, I cannot give them an antibiotic.”
If you are experiencing symptoms of a urinary tract infection, your healthcare provider should perform a urine culture before starting antibiotic therapy. Confirming the exact type of bacteria causing your infection is key to proper treatment so you can get back to feeling your best.
