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Research

Study: Most women treated for recurrent UTIs may not have bladder infections

A new study found that up to 85% of women diagnosed with recurrent urinary tract infections may actually have vulvar or pelvic floor issues that mimic UTI symptoms, leading to unnecessary antibiotic use.

AI News Feed · 2026-08-31 19:00

Maria Uloko, a urologist in Los Angeles and co-author of the study, said that most of these women did not actually have UTIs, despite repeated diagnoses. The symptoms of these conditions — burning with urination, urgency, frequency, and lower abdominal pain — are identical to those of a UTI, but they require different treatment.

Why are these vulvar conditions missed? The current diagnostic process for UTIs often begins with a urinalysis, which detects inflammation but not bacteria. A culture is needed to confirm a bacterial infection, and the sample must be a "clean catch," which patients are not always instructed on how to do. Clinicians frequently start broad-spectrum antibiotics immediately after a positive urinalysis, before culture results return.

Uloko also pointed to a lack of training among medical professionals. Doctors are taught that classic UTI symptoms should be considered a UTI until proven otherwise, and when patients do not improve, the cycle continues because physicians may not understand how vulvar health relates to urinary, colon, and sexual health.

Lindsey Burnett, a urogynecologist at the University of California San Diego and another co-author, noted that lower urinary tract symptoms can be caused by factors other than bacteria. Loss of hormones to vulvar tissue, such as during breastfeeding, menopause, or from medications like oral contraceptives, acne treatments, hair-loss drugs, cancer therapies, and hormone treatments for endometriosis or fibroids, can cause inflammation that mimics a UTI. The genitourinary syndrome of menopause can also produce similar symptoms, and chronic inflammation may lead to tense pelvic floor muscles that disrupt bladder function.

Melissa Kaufman, professor and chief of reconstructive urology and pelvic health at Vanderbilt University Medical Center, who was not involved in the study, said the findings will accelerate investigations into a more comprehensive approach to optimize care.