Magazine 15 June 2021

A precise diagnosis for a tailor-made path

Cystitis is a complex and multifactorial disease and requires an accurate diagnosis to be addressed with a tailored pathway.

The diagnosis is made in two steps:

The first thing to do before proceeding is to contact your doctor, reporting the symptoms


Test strips: a first self-assessment

The test with test strips, also known as urine sticks, allows us to make a first self-test (they are quite cheap, and you can buy them without a prescription).

To perform the correct urine test:

  1. It is recommended to test with the first-morning urine.
  2. If it cannot be used immediately, store the urine sample at 2-4° C; at the time of testing, the sample should be brought to room temperature (15-25° C).
  3. The urine specimen collection container must be clean and free of disinfectants or detergent residues.
  4. Do not touch the reaction zones of the sticks.
  5. Take only as many test strips as needed and quickly and firmly close the test strip container with the original cap.
  6. Dip the test stick into the urine sample for approximately 2 seconds. Make sure all reaction areas are wet and remove excess urine (either on the rim of the vessel or with paper towels);
  7. Keep the urine stick horizontal during the reaction period to avoid interference between the reaction zones;
  8. Compare colors with the color scale on the package only after 60 seconds (leukocytes after 60-120 sec). Any discolorations occurring only at the edge of the reaction fields or after the 3rd minute after the stick has been dipped are irrelevant.
  9. For proper visual evaluation, observe the results in a well-lit room.


We must be careful of the following parameters:

  • An excessive concentration of Nitrites indicates the presence of bacteria in the urine. Bacteria such as Escherichia Coli produce nitrites from the nitrates naturally present in urine.
  • Leukocytes are present in the urine when there is ongoing urinary tract inflammation. In normal situations, the passage of leukocytes in the urine is very low.

Please refer to the table below for a first self-assessment


Leukocytes+ Leukocytes-
Nitrites+ Bacterial cystitis Asymptomatic cystitis
Nitrites- Abacterial cystitis *see note


*If Nitrites and Leukocytes are absent cystitis should be excluded, and attention should be directed to evaluating the possible presence of other vaginal infections (vaginosis, vaginitis, candida), vulvodynia, pelvic floor hypertonus, or pelvic neuropathy.

Testing with test strips is not sufficient for an accurate diagnosis but it gives us a quick indication that must be combined with your doctor’s evaluation.

If Nitrite is detected in the urine, the next step is urine culture.


Urinalysis (with antibiogram)

Urine culture is an essential urine test to diagnose a urinary tract infection and allows us to accurately identify the species of bacteria present in the urine.

The urine collection is done in a sterile container, usually provided by the laboratory where the analysis is carried out (if not, it is necessary to buy it in a pharmacy).

It is important to properly prepare to collect urine to avoid skewing the test result:

  1. Clean hands thoroughly with soap and water.
  2. Wash the genital area thoroughly with soap and water and dry with a clean cloth.
  3. Eliminate the first jet of urine.
  4. Open the container, taking care not to touch the edges or the inside.
  5. Collect the intermediate stream of urine.
  6. Close the container tightly.
  7. Bring the sample to the laboratory within 2 hours of collection.

Note: Antibiotic therapy distorts test results and should be discontinued at least five days in advance.

The result can be:

  • Negative. There are no bacteria in the urine.
  • Positive: identification of a bacterium with a number equal to or greater than 50,000 CFU/ml (Colony Forming Units per milliliter of urine).
  • Polluted: if bacteria with a number lower than 50,000 CFU/ml is reported, the test must be repeated because it is probably falsified.

Once the bacterium has been identified, an antibiogram is performed. This is an in vitro test that allows the sensitivity of a bacterium to one or more antibiotics to be tested.

The antibiogram is an essential test, given the widespread of antibiotic-resistant bacteria.

Attention! Using the wrong or broad-spectrum antibiotic puts us at risk of relapse!

Untargeted antibiotic therapy only strengthens the harmful bacteria and kills the good bacteria (thus eliminating our natural defenses).

We, therefore, advise you to avoid undergoing antibiotic treatment unless advised by your doctor and when strictly necessary.

I wrote an educative article about a scientific study comparing d-mannose and antibiotics.

Further examinations in case of complicated cystitis

In caso di cistiti complicata o ricorrente, per inquadrare meglio la situazione, potrebbero essere necessari ulteriori esami urologici, ginecologici, gastroenterologici, endocrinologici a causa della natura multifattoriale della cistite.

Do you have an accurate diagnosis yet? Find the best solution for you among our Cystitis kits.

If you haven’t already, also read about all the causes of cystitis.

See you next time!


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