What are chronic urinary tract infections?

A urinary tract infection (UTI) is a bacterial infection in the kidneys, bladder and tubes leading to and from these organs. UTIs are typically treated with antibiotics, although they are not always necessary.

In chronic UTIs, symptoms do not go away, short term antibiotic treatments do not work and urine diagnostic tests may not show an infection. Chronic UTIs can be caused by bacteria entering the lining of the bladder.

The NHS lists various factors that increase the risk of bacteria getting into the bladder including:

  • having sex
  • pregnancy
  • blockages in the urinary tract (such as kidney stones)
  • conditions that make it difficult to empty the bladder
  • urinary catheters
  • a weakened immune system
  • dehydration
  • not keeping the genital area clean and dry

The charity Chronic Urinary Tract Infection Campaign (CUTIC) estimates there are up to 1.7 million women who suffer from chronic UTIs, alongside “a significant number of men and children”.

Symptoms

The NHS says symptoms of a UTI may include:

  • pain when peeing
  • increases in the frequency of peeing
  • changes in pee, such as it looking cloudy, blood in pee, or it being dark or smelling
  • pain in the lower tummy or back
  • a high temperature or a very low temperature

Diagnosis

Symptoms can be similar to other conditions and chronic UTIs can be hard to diagnose. There are various diagnostic tests for chronic UTIs that involve analysing urine and checking for bacteria or other germs in it. GPs can request their patients get tested for chronic UTIs in several ways, including point-of-care testing, via community diagnostic centres or via laboratories.

Treatment

Patients with reoccurring UTIs would first be referred from primary to secondary care to exclude other causes, such as through an ultrasound scan or a cystoscopy. They may then be prescribed prophylactic antibiotics.

Research 

As noted above, antibiotics are typically prescribed to treat a UTI. Guidelines published by the National Institute for Health and Care Excellence (NICE) state that daily, low-dose antibiotics are also an option to help manage and prevent UTIs among those who experience recurrent UTIs. Bacteria, however, can become resistant to this type of long-term treatment, meaning that the antibiotics become ineffective for the patient. 

A campaign on UTIs in 2023, led by NHS England and the UK Health Security Agency, noted that the use of antibiotics for treatment is a “major contributor to the burden of antibiotic resistant infections”. Researchers at the University of Oxford are investigating the optimal duration of antibiotic treatment to effectively clear UTIs while avoiding overtreating and the associated risks of bacteria becoming resistant to antibiotics. 

Rapid and accurate diagnostic testing can also help to guide effective antibiotic use. This benefits patients while reducing unnecessary prescribing and the incidence of antimicrobial resistance. The government reported in April 2025 that NHS England was supporting research “to horizon scan for new innovations in point-of-care tests for diagnosing UTIs, to better guide treatment options”. One example is the TOUCAN (plaTform fOr Uti diagnostiC evAluatioN) study (funded by the National Institute for Health and Care Research) which is evaluating new rapid diagnostic tests for diagnosing UTIs in a GP practice. Other research has looked into more frequent testing for UTIs, in patients who have recurrent infections, to help inform decisions about which antibiotic is most appropriate.  

In addition, researchers at Newcastle University and Newcastle Hospitals are running a clinical trial for recurrent UTIs. It compares antibiotics that are delivered directly into the bladder with standard oral antibiotics to see which type of treatment is best at preventing infection.  

Parliamentary materials

Early Day Motions

Chronic urinary tract infections and women’s health

Helen Maguire | 17 March 2025 | EDM 963

That this House recognises the urgent need for improved care and support for those suffering from chronic urinary tract infections (UTIs), a debilitating condition that significantly impacts quality of life; notes with concern the lack of awareness, research, and effective treatment options available to patients; acknowledges that women’s health as a whole demands greater attention, funding, research and care from the Government; and calls on the Government to prioritise investment in women’s health, improve access to specialist care, and ensure that those affected by chronic UTIs or other debilitating conditions receive the diagnosis and treatment they deserve.

Parliamentary questions

Urinary Tract Infections: Screening

14 May 2025 | UIN 50988

Asked by: Blake Stephenson

To ask the Secretary of State for Health and Social Care, what steps he is taking to improve testing for chronic urinary tract infections.

Answering member: Ashley Dalton | Department of Health and Social Care

Diagnostic tests for chronic urinary tract infections (UTIs), such as urinalysis and urine culture, are widely available across all pathology networks in England. Ensuring accurate diagnostic testing not only aids in the effective identification of infection, but can also reduce the unnecessary prescribing and overprescribing of broad-spectrum antimicrobials, directly benefitting patients who get the right treatment sooner.

General practitioners can request testing for chronic UTIs via several pathways, including at point-of-care, via community diagnostic centres, or via laboratories. Laboratories across England adhere to stringent quality standards for diagnostic tests, including the UK Accreditation Standard ISO 15189, and implement robust internal and external quality assurance schemes. Together, these measures ensure the accuracy and reliability of diagnostic testing.

The development of new products to diagnose infections more accurately is essential to ensuring we can continue to treat infections and protect public health. NHS England is also supporting research into newer, more accurate point-of-care tests for UTIs, such as via the Toucan study. Furter information on the study is available at the following link:

https://www.phctrials.ox.ac.uk/recruiting-trials/toucan-platform-for-uti-diagnostic-evaluation

Urinary Tract Infections

1 April 2025 | UIN 38743

Asked by: Luke Taylor

To ask the Secretary of State for Health and Social Care, what steps his Department is taking to help make it easier for patients with chronic urinary tract infections to receive referrals from their GPs.

Answering member: Stephen Kinnock | Department of Health and Social Care

The National Institute for Health and Care Excellence has published guidelines for the referral of patients who present with recurrent urinary tract infections (UTIs), which is available at the following link:

https://cks.nice.org.uk/topics/urinary-tract-infection-lower-women/management/recurrent-uti-no-haematuria-not-pregnant-or-catheterized/

There are specific referral criteria for women, compared to men and children. There are also guidelines in place for those who present to Pharmacy First. If the patient has had a history of UTIs, they are asked to see their general practice (GP) surgery, rather than being prescribed antibiotics by the pharmacy.

Patients with recurrent UTIs should be referred to secondary care to exclude other causes, perhaps through an ultrasound scan or a cystoscopy. Once cleared, patients may be prescribed prophylactic antibiotics.

The number of lower urinary tract symptom service clinics are locally managed and commissioned by integrated care boards, in accordance with local population need.

While there are no current plans to train GPs and urologists on recognising the symptoms of chronic UTIs, NHS England’s UTI reduction workstream was established as part of the delivery of the UK 5-year action plan for antimicrobial resistance 2019 to 2024. This workstream aims to enhance prevention, support early and accurate diagnosis, and improve the treatment of UTIs through identifying and adopting best practice, and through interventions for different population groups.

NHS England has also been working with other public bodies, including the UK Health Security Agency, to strengthen the guidance regarding the appropriate use of diagnostics, including dipsticks. GPs can request testing for chronic UTIs via several pathways, including at point-of-care, via community diagnostic centres, or via laboratories. Laboratories across England adhere to stringent quality standards, including the UK Accreditation Standard ISO 15189, and implement robust internal and external quality assurance schemes, ensuring the accuracy of the tests used.

Debates

Bladder and Bowel Continence Care

29 June 2023 | Westminster Hall | 735 cc196WH-212WH

Chronic Urinary Tract Infections

28 October 2016 | House of Commons Chamber | 616 cc620-624

Press and stakeholder materials

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Press releases and government publications


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