The bedside and laboratory investigations performed for suspected UTIs are urine dipstick, urine microscopy and culture. Imaging including US and CT are indicated in certain complicated cases of UTI.

However, before considering these investigations, it is worth considering evidence for patients treated on history alone.

One study assessed the likelihood of UTI on the basis of signs and symptoms alone [6]. The combination of dysuria and frequency in the absence of vaginal discharge and irritation had a likelihood ratio for UTI of 24.6. This supported the authors’ premise that female patients with uncomplicated cystitis could be treated on history alone.

However, many of these patients still have urine analysis. The consensus on patients with pyelonephritis and any complicated UTI is that investigation is essential.