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October 12, 2022 2 min read

I am experiencing UTI symptoms, but my urine cultures keep coming back negative. What should I do?

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By Board Certified Urologist, Dr. Yana Barbalat

In my practice, I see many patients with this complaint. Often, people who have urgency, frequency, bladder pain, or urethral discomfort with an absence of positive urine cultures feel very frustrated and anxious about their symptoms. Why are my cultures negative? What is causing this pain then?

Many people worry that their infections are not being picked up”. In fact, there are atypical organisms” that are not picked up by standard urine cultures. To address this, there are PCR urine tests that are now available to patients. These PCR tests will pick up and detect the genetic material of atypical” organisms that are otherwise not easily cultured. Occasionally, these atypical organisms can cause ongoing bladder symptoms and once they are treated, the symptoms resolve.

Aside from infectious causes, there are many other reasons why someone would experience urinary discomfort. I will discuss three very common causes in this blog.

Some people have sensitive bladders”. Their bladder lining reacts to certain drinks and certain foods. This reaction causes bladder pain, urgency to urinate, frequency to urinate, and urethral pain. The more severe version of bladder sensitivity” is called Interstitial Cystitis. People with Interstitial Cystitis sometimes have findings of bladder inflammation when the bladder lining is examined with a camera by a physician.

Foods/Drinks that can irritate the bladder are:

  • Soda
  • Diet drinks
  • Caffeine
  • Alcohol
  • Citrus food
  • Spicy food
  • Tart foods
  • Artificial sweeteners

Another cause of bladder discomfort is pelvic muscle pain. This is common and can be caused by strenuous activity (hiking, biking, and core exercising), sexual activity, and prolonged sitting. Essentially, your pelvic muscles (muscles surrounding your vaginal and anal area) are hurting, like any other muscle ache. When this happens, people feel exactly as if they have a UTI. Fortunately, there are many management and prevention options for people who have pelvic muscle pain.

Finally, another common cause for UTI like symptoms is a lack of vaginal estrogen and testosterone. The vaginal tissue relies on hormones to stay healthy. When depleted of these hormones, the tissue becomes dry and thinned out. Decrease of vaginal estrogen, which happens during and after menopause, can lead to persistent burning and discomfort in the genital area. Long term supplementation with vaginal estrogen cream will usually improve these symptoms. Some younger women who take oral birth control pills have a depletion of vaginal estrogen and testosterone. Just like post-menopausal women, these women feel a lot of discomfort in the genital area, especially after sexual activity.

In conclusion, just because you feel like you have a UTI, doesnt mean that you have a UTI. The key is to not get hung up in a cycle of antibiotic use when your urine cultures are persistently negative. Find a good doctor and get the right diagnosis. Most of these conditions are very treatable but the right diagnosis is key!

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