A woman develops urinary frequency and notices that when she passes urine it is slow to start, the stream is reduced, stops, starts and dribbles at the end, pain when she passes urine and is distressed. She goes to her GP and has her urine tested with a dipstick. The test is negative, an infection is excluded. This is wrong; the dipstick test will miss at least 50% of infections.

 

One day later the woman is much worse and returns to see a doctor. Another dipstick test reveals there is a “trace positive result” so the urine is sent for culture. Had the doctor examined the woman, they may have found her bladder was tender on compression which indicates infection. She is treated with three days of an antibiotic and advised to drink plenty, thereby diluting the antibiotic in the urine.

 

Three days later she feels partially better but not cured. The urine culture is reported as negative and free of infection: Wrong again; a standard laboratory culture will miss well over 50% of infections: A negative culture does NOT necessarily mean absence of infection. A response failure to the guideline treatment of three days of antibiotic is no surprise; 20% to 30% of patients will fail recommended treatment whether prescribed for three days or 14 days.

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So, what happens to this poor woman? She may get better, her body spontaneously defeating the infection. The infection might progress to her kidneys and she may be admitted to hospital. Instead, she might grumble on with recurrent acute infections punctuating a life of constant symptoms, exacerbated by sex, exercise, alcohol, certain foodstuffs, stress and many other of life’s normal occurrences.

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