A. Lenore Ackerman, MD, on balancing test results with clinical judgement for UTI

The American Urological Association, in collaboration with the Canadian Urological Association and the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, recently released an amendment to the guideline on recurrent uncomplicated urinary tract infections (uUTIs) in women.¹ The amendment specifically notes a greater value of a negative urinalysis in ruling out UTI.

In a recent interview with Urology Times®, guideline amendment chair A. Lenore Ackerman, MD, PhD, discusses how clinicians should balance diagnostic test results with their own clinical judgment in ambiguous cases. Ackerman is a urogynecologist at the University of California, Los Angeles.

Ackerman begins by discussing the urinary microbiome, suggesting that the mere presence of bacteria does not automatically indicate an infection, as was historically believed. Instead, she argues that a negative urinalysis devoid of any inflammation may be a better predictor against a UTI.

“It's that situation of the discrepancy between detect[ing] bacteria, but not seeing inflammation. Maybe that steers you to the idea that this isn't an infection [and] that there's something else going on that may be causing symptoms. That bacteria could just be reflective of the normal bacterial complement that resides with us naturally. That's the idea behind allowing a little bit more of a utility of urinalysis.”

However, Ackerman notes that a positive urinalysis may still be considered an unreliable metric due to numerous potential causes for inflammation unrelated to infection.

REFERENCE

1. Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline (2025). American Urological Association. Accessed September 4, 2025. https://www.auanet.org/guidelines-and-quality/guidelines/recurrent-uti