Conditions, Cystitis, Interstitial Cystitis

Better Testing For Chronic Urinary Tract Symptoms

Many chronic lower urinary tract symptoms (LUTS) may actually be associated with undetected chronic infections [1]. Testing is still based on the assumption that the bladder is sterile (and it’s not!) – I have written about the problems with gold standard urine testing in the past.

Today I would like to give you a list of some alternatives to standard urine testing.

Update: After speaking to some patient advocate groups (Chronic UTI Australia and Live UTI Free) I feel that these tests should come with a warning – they may not give us all the answers, they are expensive and they are only useful if they lead to proper treatment. Therefore, I’d recommend only getting them if you have someone who knows how to interpret them and treat you accordingly.

Microscopic Pyuria

Pyuria is the presence of pus in the urine – pus essentially consists of white blood cells. Fresh mid-stream urine is collected and checked for pyuria under the microscope. Even small amounts of pyuria can indicate infection. A culture of the same sample may also be used in addition. This method of testing is used by some of the experts in the field [1]. Any lab could theoretically do this kind of testing but it needs to be requested by a doctor.

Comprehensive urine culture

While a culture can never give us a complete picture of all microbes present, compared to standard urine cultures there are two options that could potentially give us a better picture.

Broth Culture

The bacteria are grown in a broth culture, instead of the conventional agar plate culture. Broth culture is a classic approach for isolating pathogenic bacteria and is believed by some to be much better suited for this purpose. Additionally, the culture is grown for much longer than conventional cultures, allowing enough time for all bacteria to grow. The urine specimen is also cleaned of any substances (like antibiotics) that may interfere with the culturing process. Lastly, there is no threshold for infection, rather the presence of any pathogen is treated as an infection.

The broth culture is available from United Medical Laboratories in the USA. The test costs $279 and can also be shipped outside the US for $40.

Find out more:

Urine Analysis for parasites, fungi and bacteria

This test analyses urine for the presence of parasites and fungi as well as culturing for bacteria and looking for other indicators of infection such as epithelial cells. They look for all bacteria and any bacteria.

It is available by PCI located in the USA. They also have and European distributor as well as shipping worldwide. Prices start from $157.

This is the test I personally use as a first test for clients because it is the most affordable test but still gives us a good overall picture.

Find out more:

Next Generation Sequencing

Next generation sequencing (NGS) uses DNA fingerprints of microbes and matches them to a DNA database. As such, NGS can identify pretty much all microbes that are present in the bladder. Although the labs are more accurate for picking up hidden infections such as biofilm infections, the relevant bacteria still need to be present in some form in the urine, which is why even those tests may miss some infections.

Microgen DX

Microgen screens for all bacteria in the bladder, as well as overall fungal load (although it does not identify what types of fungi are present). It does not currently identify parasites or viruses.

At $199 this test is relatively affordable, but is currently only available to patients in the US through a physician.

There are rumours that testing will be available outside of the US in the future.

Find out more:

RTL Genomics

This lab can provide a microbial diversity analysis. The DNA of microbes in a sample is sequenced and compared to validated microbial sequencing database. As far as I understand, they screen for bacteria and fungi.

This is not a diagnostic test, however, and needs to be interpreted by someone who really knows what they’re looking at.

I do not know how much this analysis costs but as far as I know they accept international samples.

Find out more:


This is the only lab currently screening for all microbes in one test. This includes bacteria, fungi, parasites and viruses.

They ship internationally and patients can even order their own testing.

Unfortunately this is also the most costly test at $400-1000.

Find out more:

Is it worth getting these tests?

If you’ve had chronic urinary tract symptoms but no infection has been found it might be time to consider other testing options. HOWEVER, testing is only useful if it leads to proper treatment. I have heard stories of people spending a lot of money on those tests just to have treatment refused by their doctor!

So unless you have a lot of money to waste, make absolutely sure that you have a doctor, integrative physician or other who is willing and knows how to work with these tests. (On a side-note: some people in America have been able to get testing on their insurance).

Please also note that short term antibiotic treatment has been found by Professor Malone-Lee to be inadequate for chronic hidden infections and you’d need a doctor who is willing to follow Malone-Lee’s method of long-term, high-dose antibiotics (if you decide to do conventional treatment).

As a natural therapist myself, I am not even sure if testing is absolutely necessary as it wouldn’t necessarily change the therapeutic approach. I often skip urine testing in favor of gut testing as I feel that this gives me better overall picture.

What is your experience with testing? Have you used any of the above labs before? Let me know in the comments!

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  1. Swamy, S., Barcella, W., De Iorio, M. et al. Recalcitrant chronic bladder pain and recurrent cystitis but negative urinalysis: What should we do? Int Urogynecol J (2018) pp 1–9


  • Reply


    May 7, 2018

    So none of these tests are covered by insurance then?

    • Reply


      May 7, 2018

      I know some people have had the MicrogenDX test on insurance and PCI testing have told me that it may be possible to get their tests reimbursed. The others I’m not sure, I’m not in the U.S. so I’m not 100% familiar with the system – you could always ask your insurance I guess.

  • Reply


    May 7, 2018

    Awesome resources as always Layla!

    • Reply


      May 7, 2018

      Thanks, Sheryl!

  • Reply


    May 14, 2018

    This is great info. Thank you. Hypothetically speaking, if one is to get one of these tests and they find out they have a previously undetected infection, what’s the next step? Antibiotics?

    • Reply


      May 14, 2018

      Yes, antibiotics for those who want to go down the conventional route – however, hidden infections need to be treated by long-term high dose antibiotics as researched and used by Professor Malone-Lee and some other experts. Guidelines have not been updated according to the latest research so you’d need to find a doctor who knows about the research or is open to learning about it and treating accordingly.
      The other route would be the natural way, e.g using herbal antibiotics and biofilm disruptors as well as friendly bacteria supplements.

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