Add us as a preferred source
Giovanna Forte, chief executive and co-founder of Forte Medical, says that if we want better outcomes for patients, improving UTI diagnosis is an important place to start.
It often starts with something small like a burning sensation. Maybe a sudden urgency or a feeling you can’t quite ignore. For many women, it’s a familiar discomfort that they learn to recognise, but not to trust. Many of us have been told that it’s “probably just a urinary tract infection (UTI)”, handed antibiotics, and sent on our way. Maybe the treatment worked. Often it doesn’t. What has stayed with me after talking to countless women about their experience with UTIs (as well as my own) is the uncertainty. Was the diagnosis right? Was the sample reliable? Was anyone really sure what was going on? This is as much a human issue as a clinical problem.
UTIs deserve far more attention than they currently receive, with ten million presentations to GPs and nearly 190,000 hospital patients in England each year, predominantly adults and women. UTIs are often treated as routine, but new findings from the National UTI Patient Experience survey (NUPE) suggest that what’s often missing is confidence in the diagnostic process itself. And that gap has consequences.
UTIs are among the most common infections affecting women and, for many, they are not an occasional inconvenience but a recurring disruption to daily life, because they were not treated right the first time. Recurrent UTIs place a significant burden on quality of life, work and wellbeing, affecting everything from sleep to social confidence. In the survey, nearly half of respondents experienced a UTI in the previous year, and 44% had two or more. So, for many women, a UTI is not a one-off encounter with healthcare, but a cycle they repeatedly re-enter, one that costs us dearly, both as a society and as individuals.
Reliant on treatment
Yet the conversation about UTIs often focuses almost entirely on treatment. Before treatment, however, comes diagnosis, and if that step is unreliable, everything that follows becomes more difficult. The survey data makes it even clearer than before that this foundational step is where the system is faltering.
Perhaps the most surprising finding from the survey was not about symptoms or treatment, but about the urine sample itself. Only 49% of respondents received clear instructions about collecting a midstream sample, which is the basic requirement for an accurate test. Most received a simple screw-top container, a method that is supposedly easy to use but can be incredibly messy and far from ideal for avoiding contamination. Just 2% reported collecting what could be considered a fully reliable specimen.
A diagnostic system is only as good as the sample it relies upon. If samples are contaminated or gathered inconsistently, clinicians may not have the information they need to make confident decisions. Women described embarrassment, confusion and practical difficulties, highlighting that this is not merely a clinical issue but also a patient experience issue. When the very first step in diagnosis is compromised, the accuracy of the entire process is put at risk.
Treating without diagnostic certainty can also carry risks. Some respondents reported serious complications, including kidney infection and sepsis – something which I have personally experienced due to lazy prescribing from an NHS GP who failed to follow guidelines, and it was pretty frightening.
According to the survey, 92% of respondents had taken antibiotics for a previous UTI, yet only 65% had ever had a sample sent for laboratory culture. Many treatments appeared to be based primarily on dipstick testing, a useful tool but one that is far from definitive. While not every UTI becomes severe, every patient deserves to be confident that decisions are being based on the best available evidence. Diagnostic uncertainty can affect how people feel about their urogynaecological health and, more worryingly, the care they receive. That erosion of trust in the healthcare system can lead to real harm.
Behind every statistic is a person navigating pain and, increasingly with UTIs, doubt. Survey comments reveal the human cost of diagnostic uncertainty, including delays in accessing care, long waits for results, ongoing symptoms despite negative or inconclusive tests, and the emotional toll of feeling dismissed or not believed. When women feel that their symptoms are not adequately recognised, trust in the healthcare system suffers.
Getting the diagnosis right with a clean midstream sample has two important benefits. First, it increases the likelihood that patients receive the most appropriate treatment, reducing the chance of prolonged, possibly painful, symptoms or complications. Second, it helps avoid unnecessary or ineffective antibiotic use. At a time when antimicrobial resistance is becoming one of the defining healthcare challenges of our era, accurate diagnosis is no longer a nice-to-have. It is a cornerstone of responsible prescribing and a safeguard for future generations.
Improving UTI diagnosis requires system-level change, starting with clearer instructions and more consistent testing for urine collection. Patients should not be left guessing about how to provide a sample that clinicians can rely on. Greater emphasis on obtaining high-quality specimens, including wider use of tools such as the Peezy Midstream device that are specifically designed to reduce contamination levels, would significantly improve accuracy as well as reduce burden on GPs and labs with second and third tests for the same infection. Faster access to testing and laboratory results is essential, reducing delays that leave patients in pain and uncertainty.
A routine inconvenience
For too long, UTIs have been viewed as a routine inconvenience. Yet the experiences shared by hundreds of women in this survey tell a different story, one of repeated symptoms, uncertainty, frustration and the fear of the actual development of chronic conditions and sepsis.
UTIs happen mainly to women – partners, wives, mothers and daughters, employees. With so many women disenfranchised by overlooked diagnosis and treatment, the day-to-day of business, home and the economy suffers unduly. This doesn’t have to happen.
Increased use of innovative, proven and evidence-based diagnostic technologies, with more thorough communication with patients around sample collection and prevention, would help ensure that decisions by both care provider and patient are grounded in evidence rather than assumption. If we want better outcomes for patients and a stronger response to antimicrobial resistance, improving UTI diagnosis is one very important place to start.
