Symptom-free UTI: To treat or not to treat

Urinary tract infections are common, especially for women. If you’ve ever experienced a urinary tract infection (UTI), you’re familiar with the symptoms: pain and burning with urination along with frequent, strong urges to ‘go.’

But what if you don't feel any of those things despite a positive UTI test result? Is treatment still necessary?

Asymptomatic bacteriuria, also known as an asymptomatic UTI, occurs when bacteria is found in the urine without the classic symptoms. It’s more common in elderly women, people with diabetes and people with bladder catheters.

Most asymptomatic UTIs, however, do not require treatment. In fact, growing research shows that the risks of unnecessary antibiotics in these cases often outweigh the benefits.

Symptom-free when you pee? It might be OK to let it be

There’s no doubt that antibiotics are useful, lifesaving drugs for bacterial infections. But new thinking about UTIs means a positive urine test alone shouldn’t always trigger treatment.

“Even if bacterial counts are elevated in your urine, prescription antibiotics typically aren’t necessary if no physical symptoms are present,” says Dr. Priyanga Jayakumar, a family medicine doctor with Sharp Rees-Stealy Medical Group. “This is important to avoid taking unnecessary antibiotics.”

Research shows that most UTIs without symptoms don’t need to be treated. A study published in JAMA International Medicine found that treating asymptomatic UTIs with an antibiotic was not associated with improving patient outcomes and was even linked to longer hospital stays.

Why antibiotics aren’t always the answer

According to the latest guidelines from the U.S. Preventive Services Task Force, screening for and treating asymptomatic UTIs provides no benefit and can do more harm than good for virtually everyone except pregnant women.

Antibiotic overuse contributes to a serious public health threat by creating antibiotic resistance. This can occur when infectious bacteria adapt to the medications. When bacteria develop resistance to overused drugs, doctors are left with fewer and riskier tools to fight infections.

Moreover, antibiotics can cause side effects and interact with other drugs. So, they should only be taken when needed.

When UTI treatment is necessary

Keep in mind that if you do experience symptoms, it’s important to seek treatment. Untreated symptomatic UTIs can cause serious health problems.

“In some cases, the infection can spread and lead to potentially life-threatening complications, including kidney infections and sepsis — especially in immunocompromised individuals,” Dr. Jayakumar says.

Additionally, antibiotic treatment for asymptomatic UTIs is recommended for certain groups of people, including pregnant women and patients about to undergo invasive urologic procedures.

If you’re experiencing multiple symptoms of a UTI — and abnormal bacteria growth in the urinary tract has been confirmed — antibiotics are usually the most effective way to fight off the bacteria. The dosage and type of antibiotics prescribed depend on the severity of the infection.

Tips to prevent UTIs

UTIs can be painful and difficult to deal with. To help prevent UTIs from developing in the first place, Dr. Jayakumar recommends staying hydrated, practicing good hygiene and urinating shortly after sex.

If you suspect you are experiencing UTI symptoms, talk with your doctor. They can provide guidance on next steps and the best treatment option for you.

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