Rethinking UTI Care: A Call for a Woman-Centred, Digitally Enabled Strategy

Urinary tract infections (UTIs) are far from trivial. Affecting up to 40–60% of women in their lifetime and 1 in 10 adult women each year, UTIs are among the most common bacterial infections worldwide. In England, they account for 3% of all GP consultations; over 10 million appointments annually; and place a huge, often invisible burden on primary care.

Hospital admissions are rising: in 2023–24, there were 189,756 admissions for UTIs, using 1.2 million NHS bed-days and costing over £604 million in hospital care alone. Older adults are disproportionately affected, with over half of admissions in people aged 70+, and women accounting for nearly 62% of all hospitalisations.

While many UTIs are uncomplicated and treated with first-line antibiotics like nitrofurantoin, the reality is far more complex. UTIs can escalate to pyelonephritis or urosepsis, contributing to 9–30% of all sepsis cases, with mortality risks highest in older adults and those with comorbidities. They are also a leading driver of antimicrobial resistance (AMR), as repeated or empirical antibiotic prescribing fosters resistance in common pathogens such as E. coli.

A critical and often overlooked challenge is diagnostic accuracy. Most women will have standard antibiotics prescribed without testing or diagnotics. Blind prescribing can be dangerous for many women. Where women are being tested this is also problematic.Current urine testing whether dipsticks in primary care or lab-based cultures frequently fails to detect the low-grade or recurrent infections most women experience.

False negatives, contaminated samples, and inability to distinguish harmless colonisation from true infection lead to blind antibiotic prescribing, repeated infections, and avoidable hospitalisation.The first, straightforward improvement is optimising sample quality. Ensuring a midstream urine sample every time would dramatically improve diagnostic precision, reduce false negatives, and inform better treatment choices. This is a low-cost, high-impact intervention that could be implemented nationally with minimal training, immediately improving care for millions of women.

Building on that foundation, point-of-care precision diagnostics could transform the UTI pathway. Smartphone-enabled home tests, pharmacy-based point-of-care testing, and AI-integrated symptom assessment can provide rapid, accurate, personalised results at the time of presentation. Combining these tools with structured data capture allows clinicians to:

• Confirm true infection before prescribing antibiotics
• Detect recurrent or complex cases early
• Tailor treatment to individual patient context, life stage, and risk factors

These interventions move care from episodic and reactive to precise and proactive, reducing unnecessary antibiotics and hospitalisations while safeguarding treatments for future generations.

A modern, woman-centred UTI pathway would integrate midstream sample collection protocols, point-of-care diagnostics, personalised treatment plans, and education on self-care and hormonal influences. Recurrent infection risk could be flagged early using digital tracking and AI analysis, ensuring timely intervention and reduced antibiotic overuse. Care would shift from single infection episodes to whole-of-life management, linked to life stage and patient context.

Beyond technology, there is a system design challenge. UTIs sit at the intersection of women’s health, urology, and AMR, yet no part of the system “owns” them. National oversight, longitudinal data, and cross-sector coordination are essential to scale innovation. Midstream sample quality and point-of-care diagnostics offer an immediate, implementable change that lays the groundwork for broader, integrated UTI care.

We have the evidence, the technology, and the clinical knowledge. By starting with better sampling and precision diagnostics, and combining this with digital and structured care pathways, we can reduce hospitalisations, protect antibiotics, and ensure that every woman’s experience is taken seriously.

UTIs are common, costly, and potentially dangerous but preventable and treatable when diagnosis is precise, care is personalised, and the system listens.

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