Screening - asymptomatic bacteria
Most of the time, your urine is sterile. This means there is no bacteria growing. On the other hand, if you have symptoms of a bladder or kidney infection, bacteria will be present and growing in your urine.
Sometimes, your health care provider may check your urine for bacteria, even when you do not have any symptoms. If enough bacteria are found in your urine, you have asymptomatic bacteriuria.
Asymptomatic bacteriuria occurs in a small number of healthy people. It affects women more often than men. The reasons for the lack of symptoms are not well understood.
You are more likely to have this problem if you:
- Have a urinary catheter in place
- Are female
- Are pregnant
- Are sexually active (in females)
- Have long-term diabetes and are female
- Are an older adult
- Have recently had a surgical procedure in your urinary tract
There are no symptoms of this problem.
If you have these symptoms, you may have a urinary tract infection, but you DO NOT have asymptomatic bacteriuria.
Exams and Tests
To diagnose asymptomatic bacteriuria, a urine sample must be sent for a urine culture. Most people with no urinary tract symptoms do not need this test.
You may need a urine culture done as a screening test, even without symptoms, if:
- You are pregnant
- You have a surgery or procedure planned that involves bladder, prostate, or other parts of the urinary tract
- In men, only one culture needs to show growth of bacteria
- In women, two different cultures must show growth of bacteria
Most people who have bacteria growing in their urine, but no symptoms, do not need treatment. This is because the bacteria are not causing any harm. In fact, treating most people with this problem may make it harder to treat infections in the future.
However, for some people getting a urinary tract infection is more likely or may cause more severe problems. As a result, treatment with antibiotics may be needed if:
- You are pregnant.
- You recently had a kidney transplant.
- You are scheduled for surgery involving the prostate gland or the bladder.
- You have kidney stones that have caused an infection.
- Your young child has reflux (backward movement of urine from the bladder into ureters or kidneys).
Without symptoms being present, even people who are older adults, have diabetes, or have a catheter in place do not need treatment.
If it is not treated, you may have a kidney infection if you are at high risk.
When to Contact a Medical Professional
Call your provider if you have:
- Difficulty emptying your bladder
- Flank or back pain
- Pain with urination
You will need to be checked for a bladder or kidney infection.
Dull RB, Friedman SK, Risoldi ZM, Rice EC, Starlin RC, Destache CJ. Antimicrobial treatment of asymptomatic bacteriuria in noncatheterized adults: a systematic review. Pharmacotherapy. 2014;34(9):941-960. PMID: 24807583 www.ncbi.nlm.nih.gov/pubmed/24807583.
Schaeffer AJ, Matulewicz RS, Klumpp DJ. Infections of the urinary tract. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier; 2016:chap 12.
Zalmanovici Trestioreanu A, Lador A, Sauerbrun-Cutler MT, Leibovici L. Antibiotics for asymptomatic bacteriuria. Cochrane Database Syst Rev. 2015;4:CD009534. PMID: 25851268 www.ncbi.nlm.nih.gov/pubmed/25851268.