FrequencyOne of the most common infectious diseases — women are especially affected; many experience at least one urinary tract infection over the course of their life
PathogenUsually bacteria — E. coli is responsible for the great majority of uncomplicated urinary tract infections
Key symptomsBurning when urinating, frequent urge to urinate, pain in the lower abdomen
TreatmentFor an uncomplicated bladder infection: symptomatic therapy possible; for more severe symptoms or pyelonephritis: antibiotics
GuidelineS3 guideline UTI in adults (DGU, AWMF 043-044, 2024 update)
A urinary tract infection (UTI) is a bacterial infection of the urinary tract. Most often the bladder is affected (cystitis, bladder infection). Less commonly the infection ascends into the kidneys (pyelonephritis, kidney infection) — this is a more serious condition that usually requires antibiotic treatment.¹
Urinary tract infections are among the most common infectious diseases of all. Women are affected considerably more often than men — due to the shorter urethra, which gives bacteria easier access to the bladder.¹,²
The current S3 guideline (DGU, 2024 update) distinguishes between uncomplicated urinary tract infections (in otherwise healthy people without relevant accompanying conditions) and complicated urinary tract infections (with certain risk factors such as urinary outflow obstruction, immunosuppression, impaired kidney function). This article mainly deals with the uncomplicated bladder infection.
2. Symptoms
Bladder infection (cystitis)
Burning or pain when urinating (dysuria) — the key symptom
A frequent urge to urinate — often only small amounts of urine
Pain or a feeling of pressure in the lower abdomen
Cloudy or foul-smelling urine
Occasionally blood in the urine (haematuria) — can look alarming but is usually not dangerous with an uncomplicated cystitis
Kidney infection (pyelonephritis) — warning signs
Fever and chills
Flank pain (on one or both sides)
A strong sense of being ill, nausea, vomiting
With these signs, get medical assessment immediately
With fever, flank pain or a strong sense of being ill, a medical assessment should take place without delay — a kidney infection usually requires antibiotic treatment and can lead to complications if untreated.
3. Causes and risk factors
Pathogen:E. coli is responsible for the great majority of uncomplicated urinary tract infections. The bacteria usually come from one's own bowel and reach the bladder via the urethra.¹
Female sex: women are affected considerably more often — the shorter urethra and the proximity to the anus make it easier for bacteria to reach the bladder.
Sexual activity: sexual intercourse can carry bacteria into the urethra. The term honeymoon cystitis describes this connection.
Menopause: the falling oestrogen level changes the mucosa in the urogenital area and can increase susceptibility to urinary tract infections.
Diabetes:diabetes increases the risk of urinary tract infections.
Catheter: a bladder catheter considerably increases the risk of infection.
4. Diagnosis
With typical symptoms of an uncomplicated bladder infection in an otherwise healthy woman, the symptom history is usually sufficient for the diagnosis — a urine culture is mostly not necessary.¹
Symptom history: burning when urinating, a frequent urge to urinate, lower abdominal pain — the combination of typical symptoms is usually diagnostically sufficient.
Urine dipstick test (stix): can give clues (leukocytes, nitrite, blood). With typical symptoms, however, it has little added value and can give false-negative results.
Urine culture: usually recommended with atypical symptoms, in men, with recurrent infections, when pyelonephritis is suspected or when treatment fails.
Imaging: usually not necessary with an uncomplicated cystitis. Ultrasound when urinary outflow obstruction or a complicated infection is suspected.
One of the most important changes in the current guideline (2024): with an uncomplicated cystitis in women, a symptomatic therapy without antibiotics can be considered first under certain conditions — with painkillers and enough fluids. Background: many uncomplicated bladder infections also heal without antibiotics.¹
Option 1Symptomatic therapy (non-antibiotic)
Painkillers (e.g. ibuprofen) can relieve symptoms while the infection subsides on its own
Drink enough — flushes bacteria out
Warmth (a hot-water bottle on the lower abdomen)
Condition: an uncomplicated cystitis in an otherwise healthy woman, mild to moderate symptoms, no signs of pyelonephritis.
Option 2Antibiotic therapy
Usually recommended with more severe symptoms, when there is no response to symptomatic therapy, with pyelonephritis, in men and with complicating factors. The choice of antibiotic depends on the current resistance data and the individual situation.¹
Uncomplicated cystitis (first line)
Fosfomycin (a single dose), nitrofurantoin, nitroxoline or pivmecillinam are usually among the recommended first-line antibiotics.¹
Pyelonephritis
Usually requires a more potent antibiotic and a longer treatment duration. The choice depends on the local resistance data.
Fluoroquinolones are NO LONGER the first choice for uncomplicated cystitis
Fluoroquinolones (e.g. ciprofloxacin) should usually no longer be used for an uncomplicated cystitis — because of the side-effect profile (including tendon rupture, nerve damage) and the development of resistance. There are more effective and safer alternatives.¹
Herbal remedies
Preparations with bearberry leaves (uva-ursi), nasturtium/horseradish or cranberry are often used. The evidence is limited for some of these remedies and somewhat better for others — they can usually serve as a supplement, but not as a replacement for antibiotic therapy with more severe symptoms.
6. Kidney infection
A pyelonephritis (kidney infection) develops when bacteria ascend from the bladder into the kidneys. It typically presents with fever, flank pain and a strong sense of being ill — in addition to the bladder infection symptoms.¹
A pyelonephritis usually requires antibiotic treatment. With a severe course, hospital admission may be necessary. If untreated, a pyelonephritis can lead to serious complications (including urosepsis).
7. Recurrent urinary tract infections
Recurrent urinary tract infections are usually defined as three or more infections per year. Relapse prophylaxis is an important part of the guideline.¹
Behavioural measures — drink enough, urinate regularly, urinate after sexual intercourse
Vaginal oestrogen during the menopause — can considerably reduce the frequency
Immunoprophylaxis — oral immunostimulation (e.g. OM-89/Uro-Vaxom) is mentioned as an option in the guideline
D-mannose — according to some studies can reduce the frequency of relapses; increasingly recommended
Cranberry preparations — the evidence is mixed, but some studies show a positive effect
Long-term antibiotic prophylaxis — considered a last option when other measures are not enough
8. Prevention
Drink enough — regular flushing of the urinary tract
Urinate regularly — don't hold urine unnecessarily long
Urinate after sexual intercourse
Intimate hygiene: wipe from front to back — no excessive hygiene in the intimate area (no vaginal douches, no perfumed products)
Avoid getting chilled — the evidence is limited, but many affected people report a connection
How brite helps you with urinary tract infections
Finishing the antibiotic course properly, even when the symptoms are already gone after two days. Taking prophylaxis preparations daily with recurrent infections. And being able to really show at your next appointment how often it happened over the last year. That's exactly what brite is for.
Medication reminder — take the full antibiotic course, D-mannose or prophylaxis preparations regularly: brite reminds you on time. Especially with short antibiotic courses, complete intake is crucial to avoid resistance. Set up a reminder
Interaction check — an antibiotic plus the pill (can affect the contraceptive effect)? Plus thyroid hormones? Plus a stomach protectant? brite shows what should be taken when and what fits together. Check now
Health history — document the frequency of the infections, symptoms, antibiotics used and prevention measures over time. That way, at your next appointment, you can clearly show whether the threshold for recurrent UTIs has been reached and which prophylaxis would make sense. Track your history
Digital medication plan — all your medications clearly laid out for urology, gynaecology and your family doctor. Helps especially when several practices are involved in your care or an emergency antibiotic reserve has been prescribed. Go to medication plan
FAQ: Common questions about urinary tract infections
Not necessarily. The current guideline (2024) provides for the possibility of an initially symptomatic therapy (painkillers, drinking) with an uncomplicated bladder infection in otherwise healthy women with mild to moderate symptoms. With more severe symptoms, when there is no improvement or with pyelonephritis, an antibiotic is usually necessary.¹
The main reason is the shorter urethra in women, which gives bacteria easier access to the bladder. In addition, the opening of the urethra is closer to the anus, where the bowel bacteria (especially E. coli) are located.
The evidence is mixed. Some studies show a certain protective effect against recurrent urinary tract infections. Cranberry preparations can be useful as a supplement but usually do not replace guideline-based therapy or prophylaxis.
A simple sugar that can inhibit the attachment of E. coli bacteria to the bladder mucosa. Some studies show a positive effect on the relapse rate. It is increasingly recommended as prophylaxis — the evidence base is growing.
With fever, flank pain, a strong sense of being ill (suspected pyelonephritis), with blood in the urine without a clear cause, with urinary tract infections in men, with a lack of improvement after a few days of symptomatic therapy or with more than three infections per year.
Fluoroquinolones (e.g. ciprofloxacin, levofloxacin) are usually no longer the first choice for an uncomplicated cystitis. They can cause severe side effects (including tendon rupture, nerve damage) and promote the development of resistance. There are more effective and safer alternatives.¹
Yes, but considerably less often. In men, a urinary tract infection should usually always be medically assessed, because complicating factors (e.g. prostate enlargement) are more often present.
Yes — drinking enough helps to flush bacteria out of the bladder. It is one of the simplest and most effective measures both for treatment and for prevention.
Medical disclaimer: This article is for general information and does not replace medical advice, diagnosis or treatment. With fever, flank pain or a strong sense of being ill, a medical assessment should take place without delay. Antibiotics should usually not be taken or stopped on your own. The choice of medication is always determined individually. Last updated: April 2026.
