Here's Why You Can Test Negative For A UTI & Still Have Symptoms

One possibility is that you really do have a UTI that's flying under the radar. One 2017 study in Clinical Microbiology and Infection found that one in five women with UTI symptoms had negative results on the standard tests, but almost all these women had UTIs according to the more sensitive quantitative polymerase chain reaction (qPCR) test.

"Standard urine cultures test for specific types of bacteria, but many women will have infections that are not able to be grown in these cultures," Rice says. "Another possible reason for a false negative test (no bacteria grown) is that often, the test requires a certain number of bacteria to be grown in culture. For instance, if someone has just urinated prior to leaving a sample and there is not a sufficient quantity of urine built up in the next voided sample, it is possible for a standard urine culture to report negative findings." A false negative can also occur if you've already taken antibiotics, so make sure not to do that.

If you think you might have a UTI that's not being detected, your doctor may be able to do a PCR laboratory test, Rice says. Dr. Jennifer Linehan, M.D, urologist and associate professor of urology and urologic oncology at the John Wayne Cancer Institute at Providence Saint John’s Health Center in Santa Monica, tells Bustle that another type of test called Next-Generation Sequencing (NGS) is even more accurate.

Even then, it may not always be clear what your results mean. Not all bacteria are problematic; some are healthy bacteria that get into the sample from the vagina, and others are just part of the urinary microbiome. So, the presence of bacteria doesn't necessarily mean you have a UTI.

"I have many patients with urethritis after intercourse who believe they have UTIs, but when I culture before and after, the cultures are negative," Rice says. People sometimes even call the UTI-like symptoms you can get from intercourse "honeymoon cystitis." If this is what you're dealing with, the symptoms should go away within a few days without antibiotics. "Often, if I prescribe natural supplements and bladder pain relief medications, the symptoms are limited to less than 24 hours," Rice says. You should still consult your doctor, but don't be surprised if they advise pain relief rather than antibiotics.

Interstitial cystitis (IC) is a chronic bladder condition that mimics many of the symptoms of UTIs — bladder and/or urethra irritation, frequent urination, and a constant feeling like you have to pee — but the causes are different for different patients. Some have visible damage to the bladder lining that appears to be causing the discomfort, but others don't.

"There are many working theories including an autoimmune component, chronic inflammation, and even neurologic causes, but currently there is no one hallmark cause and effect for this diagnosis," Rice says. She adds that generally, it's diagnosed by exclusion, meaning everything else it could be has been ruled out. Interstitial cystitis has a number of treatments, including dietary changes, medications, and procedures like bladder instillations.

Some STIs like gonorrhea and chlamydia cause symptoms like frequent urination and bladder pain that can be confused with a UTI, family medicine doctor Dr. Sheryl Recinos, M.D., tells Bustle. You should be able to rule these out or in pretty easily by getting an RNA-based test, she says.

Some people develop UTI-like symptoms in response to irritants, like caffeine, spicy foods, and citrus foods, because their bladders are hypersensitive, Linehan says. You can test for bladder hypersensitivity with a urodynamics test, where the bladder is filled with a very small amount of fluid. "If the patient reports that they have to urinate when only a small amount is in the bladder, that is hypersensitivity," Linehan says. Often, this problem will go away through dietary changes you work out with your doctor.

Pelvic floor dysfunction is improper positioning of your pelvic floor muscles, which surround your bladder, bowels, and reproductive organs. If the muscles around your bladder are too tight, this can lead to bladder or urethral pain and/or frequent urination.

Sometimes, the dysfunction comes from having had a UTI in the past, Stephanie Prendergast, CEO and co-founder of the Pelvic Health and Rehabilitation Center, tells Bustle. "A UTI is a painful visceral experience which causes pelvic floor muscle tightening in response to the pain," she says. "Sometimes the muscles do not relax after the UTI is treated with antibiotics, especially if the person has had a number of infections in a short period of time." You can see a pelvic floor physical therapist to get evaluated and treated for pelvic floor dysfunction.