When is a UTI Not a UTI?

Yeah, not quite a lot of variation, a huge amount of variation, Andrew.

And I want to reinforce what you said earlier.

I think our audience will probably know more about this than we do, but we think it's really helpful to make some comments, especially in context of chronic kidney disease.

And as you say, it sort of appears straightforward.

But when you start to look at the details, there's just huge amounts of uncertainty around this whole area.

So the biggest challenge first off really is that first question.

Is this actually in the person in front of you a urinary tract infection? And actually, in reality, we all know that a true urinary infection is often a clinical diagnosis without needing any sort of laboratory support.

And that's based on a patient's symptoms.

They've got new onset dysuria, burning when they pass urine, urinary frequency, some urgency with or without pain.

And in those sorts of cases, a patient presenting like that, they may not need any lab testing of any sort to diagnose a urinary infection.

And in some of those patients, actually, if you end up with a sort of dipstick that doesn't quite fit your clinical picture, actually, you might actually not make the right diagnosis.

And the other way around, often patients have got asymptomatic bacteria and they don't have an infection and we might be doing more harm by good by treating.

So this is quite tricky, isn't it? The separation of symptoms from urinary testing, which we both talked about before.

Yes, I agree.

It's a difficult situation, but I think I'm going to take away a key message here that you've given, which is the importance of symptoms and yet the importance of also being cautious about over-treating or treating asymptomatic bacteria.

Although my understanding, although I'm not an expert, is that in pregnant women, you do treat asymptomatic bacteria with antibiotics, but not in the general population.

Isn't there a flip side, Jeremy, in that patients with nonspecific symptoms, particularly older adults, we can easily over-diagnose UTIs.

So the second key question is when should people be sending urine for culture?

I think that's exactly right, Andrew.

And then, of course, poor GPs in primary care get hit by the fact that new confusion might be driven by possibly a urinary tract infection, even if there is no other symptoms.

So that issue, when to send urine culture so you don't over-diagnose urinary tract infections and when to interpret the results.

And your previous point was absolutely right, that issue about asymptomatic bacteria.

So when to send urine for culture? So I think that particularly in elderly and postmenopausal women, where we really want to make sure people really have got a true urinary infection, that's where problems really arise.

So in younger women with symptoms, it's a bit easier and you won't need to send urine cultures at all.

But it's much more important, I think, often in older people.