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bladder infections, evidence based medicine, tests

My urine culture is negative, can I still have a bladder infection?

In a word, yes.

And this is a difficult concept for many doctors to get because we have long been taught that the gold standard is culture.

Let’s back up a little. These are the symptoms of a bladder infection:

  • needing to empty your bladder a lot (urinary frequency)
  • when you gotta go, you gotta go (urgency)
  • pain just over the pubic bone
  • blood in the urine
  • burning when you empty your bladder, some women say it’s like peeing razor blades (dysuria)

If you have any one of these symptoms of a bladder infection there is a 50% chance you have one. If you have both burning when you pee (dysuria) and need to go a lot (frequency) and don’t have vaginal discharge or vaginal irritation there is a 90% chance you have a bladder infection.

So with this information in mind, if your symptoms are classic there’s a pretty good chance you have a bladder infection and you may get treated over the phone without a culture. However, if your symptoms aren’t classic or you have been suffering from recurrent infections your doctor should do a culture, meaning have the lab try to grow bacteria from your urine. Another advantages to growing the bacteria are to confirm you are on the right antibiotic.

So what if the urine culture is negative, but you or your doctor are convinced your symptoms are a bladder infection?

Bacteria colonies (not from a lab, this is from my kids’ science fair project, but you get the picture)

Urine cultures report the amount of bacteria in the urine, and usually only report 100,000 colonies (groups) of bacteria per ml of urine (see this clip if you want to see how it’s actually done) or more. Many labs report 10,000 colonies of bacteria/ml of urine or less as negative although some use 50,000 colonies/ml as their negative cut off. The problem? At least 30% of adult women with a bladder infection will have 10,000 or fewer colonies/ml.

So….what’s a girl who thinks she has a bladder infection to do?

If your symptoms are not so classic, most doctor’s will get a microscopy test (look at the urine under the microscope) while waiting for the culture. The microscopy test is about 87% accurate, meaning it will still miss some infections.

But there may be a situation where your or your doctor are pretty convinced you have a bladder infection (either based on your symptoms or the microscopy) and then the urine culture is read out at negative. On the assumption that you could be one of those women who gets an infection with 10,000 or fewer colonies of bacteria per urine it may very well be worth treating you for a bladder infection to see if you improve. Follow-up is essential because you should be feeling almost 100% within 48 hours, so if you are not then something else may be going on.

In an adult woman a negative urine culture does not necessarily rule out a bladder infection.

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Remember, this post does not represent direct medical advice

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Discussion

19 thoughts on “My urine culture is negative, can I still have a bladder infection?

  1. Is this applicable to children?

    Posted by wonderiguana | January 15, 2013, 2:32 am
  2. I just went to er the other day for uti symtoms. My blatter really hurt. I was having blatter spasms I took five pills of cipro I hhad left. The doc checked my urine and said it was perfect. No infection and no white blood cells in my urine. Im tired and was in pain. she would not give me antibiotics. Its been 2 days sense I went and pain has let up but still feel twinges. It doesnt burn to pee but mt blatter hurts when it is full. I took azo and it helped. I also had a pelvic exam for stds and they said everything looks great. Im still tired. I need to get back to work. I cant do this anymore. Is it possible I could have strained my blatter muscle

    Posted by Tammy hodge | May 1, 2013, 7:59 am
    • I have the exact symptoms and problem you have mentioned. How did this end up for you? I just don’t know what to do I have been taking antibiotics for a week now, in constant pain, and they found no bacteria. Any insight would be greatly appreciated.

      Posted by Amber Warfel | October 23, 2013, 1:08 pm
  3. Thank you for this insight. I am 34 weeks pregnant and was just hospitalized a month ago for a bladder and kidney infection and the culture came back negative the doctor sent another one at my follow up appointment. It too came back negative. When I went to the doctors office today for the symptoms of a bladder and kidney infection my urine read high levels of the infection but my culture was again negative so my doctor did not treat. I do not want to end up in the hospital again so I’m glad to read this information and will be contacting my doctor shortly about figuring a solution.

    Posted by pregnant lady with a problem | June 18, 2013, 12:25 pm
  4. I have been suffering from kidney infection that became chronic for 3 years. It ruined my life and my career. However every time a lab tests my urine, it comes back negative. Someone, please help me. I treated myself with Cipro when I got it first. It was kidney infection to begin with, no UTI. The infection returned after a month, I took Cipro again due to lack of insurance. The infection came back third time and I took Cipro again. Now I am resistant to Cipro, not sure what else left. Every doctor I go to says that it is all in my head and I am in perfect health. I have morning nausea, chills, fatigue, lack of appetite and lower back pain and nasty stinky night sweats. When I tell doctors, they do not even listen, they just look at the urine culture test and it is negative. I really need help, please. I do not want to lose my kidneys. I have insurance now but it does not help since the doctors will not even listen to me.

    Posted by Inna | July 16, 2013, 11:29 pm
    • Inna

      My heart went out to you when I read your post. I had a 6-month kidney infection in the UK a few years ago. The doctors and the hospital just kept sending me away with antibiotics and I was just so horrendously ill. I was off work for six months. I now live in Australia, and I had a another bad one last year. However, as soon as I rocked up at the hospital they took me straight in and placed me on intravenous antibiotics and I didn’t have to suffer again like I did in the UK. They were fantastic. They did a urinary test at the hospital and it was negative (as I was on antibiotics), and not long after they administered the intravenous antibiotics my blood pressure dropped considerably (as it was so high with being so ill) and my heart rate dropped to a healthy level.

      I have another one at the moment but it’s “mild” compared to the others. I fell ill in work last week and felt horrendous; thought I was gonna die!! I had a temperature, my blood pressure was high and my pulse was racing; all sure signs of a kidney infection. Within 8 hours the antibiotics started to work, and burning and squeezing pain in my kidney started to lift. Yet the urine sample that was tested grew nothing.

      As ever, one lot of antibis is never enough and I had to go back to see another out of hours doctor today as I could still tell the infection was there, and there was a slight trace of protein, so he’s given me a different lot of antibiotics and I can feel them

      Can you take a different antibiotic? Or a lower dose over a longer period of time? Have you tried to get an appointment with a urologist? They’re usually very good, very thorough, even if your everyday doctors won’t listen to you.

      Let me know how you’re getting on.

      Posted by GladwysStreet | August 11, 2013, 4:13 am
  5. Please, please respond. I am so desperate. I can’t find anyone to help me.

    I have had bladder infection symptoms for over 3 years. Every single culture has come back negative. I’ve been to a urologist numerous times-he tells me it is ‘getting used to intercourse’. I’ve been married 3 years now and apparently I’m still not used to intercourse because the bladder issues are still there.

    I have intense low back pain, frequent urination even after drinking nothing for hours, and a crampy/dull ache where my bladder is. The back pain is horrendous and it gets very bad when the bladder symptoms are at their worst. I also have pain with intercourse which started when the bladder thing started. Also, when this started, I begun waking up at 4am, unable to go back to sleep. I am so exhausted everyday of my life.

    I’m living a nightmare.

    My doctor won’t give me antibiotics because the culture is negative. I can’t get in to see another urologist because my doctor has to refer me and he thinks nothing is wrong with me since I already went to one urologist.

    I’m scared something is very wrong inside me. It’s gone on so long. This is the ONLY blog I’ve read that admits there could be something beyond the culture. It gives me a sliver of hope.

    Posted by Heather | August 22, 2013, 7:19 am
    • This response is not medical advice.

      A urinary tract infection is not the only cause of needing to go to the bathroom a lot and pain with sex has many causes. Two common causes of both symptoms are pelvic floor muscle spasm and interstitial cystitis. A pelvic floor physical therapist can evaluate pelvic muscles if a doctor is not able to do that. A urologist should be able to diagnose painful bladder syndrome (PBS). This is a link with some more info on PBS http://www.examiner.com/article/understanding-painful-bladder-syndrome

      Posted by Dr. Jen Gunter | August 24, 2013, 10:12 pm
    • Heather, I posted earlier here crying about my kidney infection. I am better, knock on the wood. I got 2 different antibiotics without prescriptions and took them for over a month, one is 5-nok I( Nitroxoline) and another Furantoin. I had no choice since no doctor would help me. I was going crazy. I went on diet, no spicy food, no fried food, no salty food and no rich foods. Basically plant based, easy to digest diet. I feel alive again. I have been married for 12 years but sometimes I get kidney infection after having sex so we do not do it anymore. Believe or not, my husband have seen me suffering and he does not want me to be sick again. I just have no choice, no sex for me. Actually when I am sick, I have no sex drive anyways.
      Bottom line, read online what antibiotics are good for bladder infection. Also sounds like you are developing kidney infection as well. Get on antibiotics ASAP. If you are in US, you can get them online through Canadian pharmacy without prescription. I got mine from Europe, a friend of mine brought it for me. Also after sex, you have to urinate. This way you wash the bacteria out of your urethra. Read online, there is tons of info. I have educated myself on this subject. Also you cannot have alcohol or coffee, or an caffeinated drinks at all, forever and ever. It will make your condition worse. One more, get Uva Ursi, it is an herb. Make a tea and drink it. Also chew on leaves throughout the day. It kills bacteria.
      Good luck. Keep me posted. I hope you will get better.

      Posted by Inna | August 24, 2013, 10:23 pm
      • Glad you got help. I too suffer from uti’s and almost died from kidney infection when I was 19. I went in to doc for painful urination. Culture done was negative so no antibiotics for me until I was almost dead. I recently got another uti. I’m 44 I know what they feel like and went to doc. He gave me antibiotics for 3 days I felt better culture was negative. Following month peeing blood and called doc he gave me 3 days Cipro and I took and went to see him on a Monday and culture done again negative and he was quite nasty about it too and all but accused me of lying about symptoms but he had already given me 7 days worth of antibiotics that I had started to take. I took them all and it’s a year later no reoccurrence. I have new doc can’t deal with someone who doesn’t believe me.

        Posted by Ericka | October 24, 2013, 3:52 pm
    • I would like to let you know that you are not the only one. I have recurrent uti’s-honeymoon cystitis often after sex. Four women in my family have the exact same problem. We go to the doctor because we know we have a Uti, but their tests usually show negative. They usually give me antibiotics anyway. Amazingly, every time I use the antibiotics, all symptoms go away. At one point I started having significant back pain that I suspected was a kidney infection. I went to the Dr. and she said the culture was negative and said something to the effect of, “Well, honey, you’re not twenty anymore. Sometimes you get back pain as you get older.” She basically told me to suck it up. So, I went home and sat in the floor and cried because I thought my career was going to be foreshortened due to back problems. So, a little while later I went to urgent care for uti and they treated me with antibiotics which I took religiously and . . . amazingly, all my back problems miraculously went 100% away. My back felt like I was 20 again. So, all of my back problems was a kidney infection that they could not diagnose with their little machines. This has happened a couple of times now. Repeatedly I have used the AZO home tests which turn purple indicative of infection then go to the Dr. and there test is negative. There machines are not accurate enough. I currently have a kidney infection (I know because of the exact same back pain) and I went to the Dr. today who discovered I had a fever of 99.7, yet my urinalysis showed negative. He prescribed me antibiotics anyway which I will take and I will guarantee you all my back pain will be gone, yet again. I would highly recommend you find another Dr. who will listen to you. I just read an article that said, “One study found a large fraction of fastidious and anaerobic bacteria (22.43%) was not detected under culture conditions, but only by using PCR.” I found out today that there are specialists called urogynecologists. That might be a good bet.
      Good luck!

      Posted by Nicole | December 31, 2013, 11:40 pm
      • Funny, PCR is used in Ukraine to test bacteria. Poor Ukraine has better diagnostics than USA. I ended up treating my chronic kidney infection with herbs and oils. Oregano oil works taken internally. Basically you need to kill the bacteria. Mine became resistant to antibiotics but never ever got diagnosed by any doctors. It has been 3 years since I had my first acute kidney infection. I have come a long way. I educated myself on the subject well. I do not trust doctors anymore. I probably would have died or been on dialysis right now if I listened to them. their motive is profit and not my well being. Try natural remedies like oils. Oils are very strong but you will not develop resistance. Also I read this book called Natural Antibiotics and I used that info to help myself. It works.
        Take care,
        Inna

        Posted by Inna | January 1, 2014, 3:52 pm
    • look up i.c.

      Posted by lorrie | July 9, 2014, 4:00 pm
  6. This morning I was awoken with the worst burning feeling in a long time and needed relief right away. It was 3am so the doctor’s office wasn’t open. I dug through my sister’s medicine cabinet (I was staying at her house thank god) and found Lady Soma Cranberry Tablets. I highly recommend this product in everybody’s medicine cabinet. The product worked within 20 minutes and I was able to go back to sleep!

    Posted by NYC maven | November 5, 2013, 1:30 pm
  7. had a stroke 2 yrs ago, about 6 months started getting tight muscles then knocked off my feet, was treated in hospital for uti which cleared ,since then have had uti symptoms urine tests keep coming back negative, yet still got symptoms of uti and my muscle tightness is getting much worse can hardly move now ,doctor insists I haven’t got infection that I have to see a urologist im in agony not convinced ,

    Posted by Elizabeth Marshall | December 11, 2013, 3:39 am
  8. Pls help. My mother is 64 year old and complaining pain in the lower abdomen. Her urine was cultured and negative results but still the pain when urinating doesnt go away. No blood but the pain still on.

    Posted by Beth soriano | March 18, 2014, 6:29 pm
    • I would just start taking antibiotics. Will not hurt. If it does not work, you will go from there. But if you wait and it is an infection, then it can spread to kidneys. And that is not good.

      Posted by Inna | March 26, 2014, 11:09 pm
  9. Ooopps. This is what happened to me also, I started taking antibiotics and it had worsen the situation. You’d better go to the doctor and seek expert advice. As for me I started taking cranberries. It really helped me.

    Posted by Alice | August 11, 2014, 11:20 pm

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