Where to get a urine analysis for your UTI
In addition to your primary care physician, GP or secondary consultant offering dipstick and standard mid stream urine tests, the following companies also offer analysis. Each company uses different analysis techniques. These are:
- Mid-stream urine culture (MSU)
- Urinary Broth Culture
- Expanded Quantitative Urine Culture (EQUC)
- PCR (polymerase chain reaction) and/or Next Generation Sequencing
- Microscopy of an immediately fresh urine sample
Find out about the different tests for UTI.
Providers will answer any questions before submitting a test for analysis. Be aware that that the cost of these analysis methods may not be included in healthcare schemes in your home country and costs can be considerable.
Each name links to the provider’s webpage.
Medichecks UK (mid-stream urine culture)
Medichecks UK more information
Medichecks offer a detailed urine culture but only if after an initial culture of 18 hours, markers of infection are found. These include any of the following:
- white blood cells
- bacteria (after 18 hour culture)
- red blood cells
- nitrates
- epithelial cells
- protein
If these are determined on initial culture then it will be cultured for longer. Initial notification of the results will be emailed and can be downloaded from their website. Medichecks will also provide antibiotic susceptibilities and resistances to the bacteria found in the sample. The test can be ordered online or over the telephone and there is an option in the online order process to provide a medical history to help the laboratory during analysis. Medichecks have a Customer Service line that can answer any pre and post test questions.
Focus Laboratories UK more information
UK based, managed and founded by Focus Medical Clinic, Focus Laboratories offer Extended Quantitative Urine Cultures alongside Liquid Broth Extraction.
You are offered a choice of diagnostic options:
(a) place a direct order without the need for a signed GP authorisation which will provide analysis of your urine culture, bacterial identification and antibiotic sensitivities plus a short clinical recommendation for treatment.
(b) for an additional cost, a signed GP referral which will provide all the services of (a) as well as a more detailed clinical letter including an explanation of your results, medication recommedations including dosage and duration and naturopathic options. Results and advisories will be emailed/posted to the referring GP/Specialist and you will also receive a copy. Note you must send your signed GP referral form BEFORE ordering your test kit.
Download your GP referral form here:
https://focuslabs.online/referrals/
Their specialist, clinical microbiological interpretation will differentiate between commensal bacteria found in the vaginal or urinary tracts and pathogenic, infection causing bacteria.
In addition to test kits for urine analysis, vaginal/penile swab kits can also be ordered for fungal or vaginal infections (note for fungal specification an additional cost is charged due to a different laboratory providing this service).
It takes 7 days to thoroughly test your samples. The results of your test will be emailed to you within a further 3 working days, along with potential treatment options and next steps.
Invivo – UK (PCR Testing)
Invivo – more information
The Urinary EcologiX™ test from UK based Invivo Laboratories has been specifically designed to investigate the female* urinary microbiome by assessing key commensal, pathobiont, and pathogenic bacteria commonly associated with urinary conditions.
Using quantitative real-time PCR (qPCR), this test provides an accurate analysis of the microbiota abundance in the female urinary system. As qPCR measures the amount of bacterial DNA present in the sample, it enables us to detect and quantify the presence of commensal, pathobiont and pathogenic bacteria that can sometimes be hard to read in traditional culture methods. This information can be used to inform changes in a client’s lifestyle, nutrition, self-care or other interventions. The turnaround time for this test is 15 days.
Please note you can only request this urine test through an accredited heath care professional working with Invivo Labs. You can request details of registered specialists using the link below.
List of registered healthcare providers
AIM Laboratories US more information
US based and utilising PCR (polymerase chain reaction) for UTI pathogen identification, quantification and detection of antibiotic resistance.
AIM’s UTI solution is one of the fastest available, reporting both pathogen identification and antibiotic resistance testing results within 12 to 24 hours of receiving the patient’s specimen.
A referral from a GP or physician/consultant is needed.
MicroGen DX Laboratory – USA (PCR and Next Generation Sequencing testing)
Microgen DX Laboratory more information
US based, MicroGen DX use Molecular Diagnostics of PCR and NGS to identify the microbes by extracting the bacterial and fungal DNA within each sample.
A two step process is offered, firstly using PCR analysis against a database of 21 common pathogens and then a more detailed, second level gene analysis is offered. This looks for a specific gene that is common to all bacteria, called 16s ribosomal RNA, and a gene common to all fungi, 18s ribosomal RNA. This genetic material is then compared against their database of micro-organisms.
They also detect antibiotic resistance genes for 10 antibiotic classes and deliver an antibiotic recommendations sheet. Turn around for PCR testing is 24 hours and NGS in 3-5 days.
To submit a sample, patients can choose either the US or International Test Kit option. A referral from a GP or Physician/Consultant is not needed. Test kits can be ordered for urine, vaginal anaerobes or sexually transmitted infections. Individual or combination test options are available and there are gender specific kits available.
MicroGen can also provide a listing of US physicians they are working with to help patients looking for clinical support using their testing. They can also provide interpretation of results for patients and clinicians once the results have been received. However, for international patients when ordering a test, no antibiotic sensitivities/resistances can be provided without the signature of a physician.
Regenerus UK more information
Regenerus UK offer the range of Microgen DX UTI laboratory tests for both men and women. Turnaround is 7 days from receipt of the samples. You can order directly from them and receive the results via their online portal. The results provide antibiotic susceptibilities and resistances against each bacteria identified but they do not offer clinical interpretation of the results.
Regenerus has recently launched a MicroGen DX UTI referral service with Dickson Chemist. UK patients are now able to be referred for prescription with Dickson Chemist, a national pharmacy. Dickson will accept MicrogenDX UTI report referrals and complete the prescription for the patient.
Regenerus says, “this is a huge benefit to our MicrogenDX UTI customers because it will give them access to their prescription quickly, easily, affordably and safely. Previously, MicrogenDX UTI users faced significant barriers to get hold of the specialist antibiotics the test recommend. ”
Dickson Chemist/Microgen DX
Pathnostics more information
US based, Pathnostics offer a test called Guidance UTI, a unique rapid molecular test for both pathogen identification and antibiotic sensitivity, backed by patented technology. Guidance uses polymerase chain reaction (PCR) to detect DNA from pathogens for UTIs and for prostatitis. Turnaround on receipt of sample and delivery of results in 24 hours.
A referral from a GP or physician/consultant is needed. In addition to test kits for urine analysis, HPV screening for cervical cancer tests can also be ordered.
Pathnostics can also provide a listing of US physicians they are working with to help patients looking for clinical support using their testing. They can also provide interpretation of results for patients and clinicians once the results have been received. They are unable to accept samples from international patients unless they are in treatment with a US practitioner.
Digital Microbiology UK more information
SBL is a UK based (Community Interest) Company dedicated to improving patient treatment options through high quality, collaborative and clinically focused research. The laboratory is based in the UK.
They now offer Urine and Vaginal microbiome analysis for bacteria, yeasts and viruses using long sequences of microbial DNA taken directly from a sample with no need for PCR. This means they are able to bypass PCR testing which commonly looks for around 20 pre-defined species missing many more microbes and they often report contaminants. More advanced testing such as 16s rRNA can provide more detailed data but only report bacterial families rather than individual species and accurate specification quantities.
Sample are analysed against 4,000 different species of bacteria, 11,000 different viruses and 21,000 different plasmids. Plasmids are small circles of DNA that bacteria can share between them. Some allow them to become resistant to different antibiotics so tracking them can be important. Plasmid and virus identification can be shared with a health-care professional if asked.
All detected organisms are reported to species level and does not list unknown members of a particular bacterial family. For some species, such as E. coli they predict which serotype the E coli is likely to be and which strain it most closely resembles. This information can be very useful to a health-care provider.
Unlike most other testing systems, they can easily differentiate between species of Shigella vs E coli and other very closely related organisms such as Lactobacillus gasseri vs Lacrobacillus paragasseri.
Testing options include individual urine analysis, vaginal swab analysis or combined urine/vaginal analysis. Provision of microbe specific advice to help you understand your results; what’s normal and what might be a problem is offered in a report. Also included is information on antibiotic sensitivity data for your species of interest and the ability to select any or all of your data to share with a medical professional.
Results of the urine and vaginal swab tests are made available within 48 hours through your online account portal.
Fresh urine microscopy – UK
Fresh urine microscopy testing is only available to NHS patients in treatment at the Lower Urinary Tract Symptoms (LUTS) Clinic at the Whittington Hospital in London or to private patients in treatment with clinicians at The Artemis Cystitis Clinic, 10 Harley Street in London.
Fresh urine microscopy more information
A sample of fresh urine taken at the clinic is dropped onto a plate for immediate analysis under a microscope.
White blood cells and epithelial cells are counted as markers of an infection.
When infection occurs in the urinary tract, the immune system tries to remove infected cells by shedding the cells in the bladder lining (the epithelium) to be excreted during urination – these are known as epithelial cells.
A high white blood cell count usually indicates that the body is fighting an infection. White blood cells rush in to help destroy the harmful substance and prevent the infection developing further as part of the immune system response to pathogenic bacteria.
The need for immediate analysis of a urine sample is because white blood cells degrade very quickly. Studies have shown this occurs in as little as four hours unless collected in an appropriate sample bottle containing a boric acid preservative. A sample sent for analysis at the laboratory may not identify sufficient or any white blood cells if there is a delay in the delivery and analysis within a four hour period or urine collection does not involve a sample container that utilises boric acid to help preservation.
What to know before submitting a culture
Full instructions as to how to collect the sample, the packaging required and how to mail it will be provided by the relevant laboratory.
Unless otherwise advised by the company you are testing with ensure all bladder medications such as antibiotics are stopped for at least seven – ten days prior to providing a sample for testing. Note: if you are providing a sample for fresh urine microscopy no medications, bladder or otherwise need to be stopped.
If you are using D-Mannose or other natural herbal supplements to treat your infections stop at least 48 hours before testing.
The reasons behind these timings is due to the body life of the antibiotic or supplement taken and how long it resides in the body which will affect test results. Always contact the laboratory or your specialist to discuss medications in advance of testing (with the exception of fresh urine microscopy where this is not applicable), including any medications for other conditions i.e. thyroid, bowel etc. They will be able to advise as to what can be continued and what needs to be stopped and the relevant time-period for cessation.
In all cases, a urinary painkiller such as Azo should be stopped 24 hours before a sample as urine samples will be affected by this medication. Diuretics should also be stopped as well as Vitamin C – all can lead to false negative results.
Some top tips to ensure you submit a clean catch urine sample – meaning your sample does not also contain vaginal or vulval debris or discharge and is dismissed at the lab as being “contaminated”
- Wipe your vulva and labia with a baby wipe or wet toilet tissue – vulval and vaginal epithelial cells are a different shape to those shed by the urinary tract and you want only urinary epithelial cells in your sample.
- Place a balled up wet baby wipe into the entrance of your vagina before you collect your urine sample. This prevents transfer of vaginal secretions into the urine sample.
- Hold your labia apart before you collect the sample.
Try to provide an early morning sample as it will be more concentrated. If this is not possible, limit fluids for around three hours before providing your sample so it isn’t too dilute.
It is recommended that any testing is carried out when experiencing a ‘flare’. This occurs when bacteria are released from the bladder wall cells leading to an increase in symptoms. The greater the concentration of bacteria will lead to more bacterial identification.
Research recently published in the International Urogynaceology Journal has shown that a first stream urine sample rather than mid-stream contains the largest quantity of urinary sediment at the base of the bladder neck due to the effects of gravity and this reduces over the course of the voiding process. You may want to consider providing a sample which catches the first stream to ensure all bacterial, epithelial and white blood cells are included.
