Millions of Women May Be Misdiagnosed With UTIs They Don't Actually Have

A Diagnosis That Keeps Cycling Back — With No Real Answer

Every day in her Los Angeles urology practice, Dr. Maria Uloko sees the same patient: a woman diagnosed with recurrent urinary tract infections, who has taken repeated rounds of antibiotics and is confused about why the infections keep coming back. For many of these women, the frustrating answer is that they never had a UTI in the first place.

Uloko tells these patients something that often feels both revelatory and frustrating: "Most of them don't actually have UTIs, even though that's been their diagnosis time and time again." She adds, "In fact, millions of women are being treated for UTIs they may not actually have."

What the Research Reveals

Uloko is the co-author of a study published in The Journal of Sexual Medicine. She and her fellow researchers reviewed the medical records of 253 women with recurrent UTIs and found that just 15% showed evidence of problems limited to the bladder or urinary tract. The remaining 85% had signs of hormonally driven inflammation of the vulvar region, and 75% had pelvic floor dysfunction.

These conditions produce identical symptoms to UTIs — burning with urination, urgency, frequency, and/or lower abdominal pain — but require entirely different treatment. That's the crux of the problem. Doctors are treating the symptom they recognize rather than the underlying condition they may not be looking for.

As Uloko explains, "So now you have a patient who is testing positive on urinalysis, sometimes growing actual bacteria on culture, receiving antibiotics, getting temporary relief mostly because of the anti-inflammatory properties in antibiotics, and then cycling right back into symptoms because the underlying hormonal and vulvar dysfunction was never addressed." It's a cycle that can go on for years.

Why the Wrong Diagnosis Keeps Getting Made

Part of the problem lies in how patients are tested: the first test typically given to patients who present with UTI-like symptoms is a urinalysis, which tests for inflammation — not a bacterial infection. That distinction matters enormously. Inflammation can be caused by many things, and flagging it as infection sets off a chain of unnecessary antibiotic prescriptions.

Common culprits behind hormonal disruption include oral birth control, which is one of the most commonly prescribed anti-androgen medications that can disrupt the hormonal balance in vulvar tissue. Other medications that can cause vulvar inflammation include acne treatments like isotretinoin (Accutane), hair loss drugs like minoxidil (Rogaine), and cancer treatments such as aromatase inhibitors and selective estrogen receptor modulators.

Unfortunately, many clinicians aren't comfortable performing even a basic physical exam of a woman's pelvis. As Vanderbilt University Medical Center's Dr. Melissa Kaufman notes, "It's a simple exam to look for diagnostic changes around the vulva and openings to the vagina and urethra — one that doesn't even have to involve a speculum or a pap smear."

What Women Can Do Right Now

Kaufman, a professor and chief of the division of reconstructive urology and pelvic health at Vanderbilt University Medical Center who was not involved in the research, says Uloko's study provides insights that could help patients with urinary tract symptoms. The key is getting doctors to look beyond the bladder.

Uloko recommends that patients print the research and bring it to their appointment. "If you've asked directly and collaboratively, 'Have you considered this angle for my recurrent UTIs?' and you're dismissed, ask the clinician to document the refusal in your chart, in writing," she says. "This changes behavior and leaves you a record."

The broader implication is hard to overstate. A diagnosis as common as a UTI — one often handled quickly over the phone or via telehealth — may be masking a completely different condition in a staggering number of women. As awareness of this research grows, the hope is that the medical community will begin approaching recurrent urinary symptoms with a wider diagnostic lens, sparing patients from years of ineffective treatment and the mounting risks that come with repeated antibiotic use.