Urinary tract infections (UTIs) are common, particularly among women. Between 50% and 60% of adult women will experience a UTI at some point in their lives, often presenting with uncomfortable symptoms like pain or burning during urination (dysuria), urgency, and frequency. Patients often wonder whether they should see a primary care physician, an urgent care clinic, or their gynecologist for this common complaint. The role of the Obstetrician/Gynecologist (OB/GYN) in managing these infections is often misunderstood, but they are frequently the first and most appropriate provider for diagnosis and treatment.
OB/GYN Scope of Practice for UTIs
An OB/GYN is qualified to diagnose and treat uncomplicated UTIs, especially since the female urinary tract and reproductive system are in close proximity. This proximity means that many symptoms felt in the pelvic region can relate to either system, placing the OB/GYN in a strong position to evaluate the issue. For otherwise healthy, non-pregnant women, the gynecologist often functions as the primary care provider for this specific type of infection.
An uncomplicated UTI is defined as an infection, typically cystitis or a bladder infection, that occurs in a non-pregnant woman who has no underlying structural or functional abnormalities. These infections are confined to the lower urinary tract (urethra and bladder) and do not involve the kidneys. Since the majority of UTIs fall into this uncomplicated category, your OB/GYN routinely manages these cases effectively using established clinical guidelines.
Diagnosis and Treatment Protocols
The diagnostic process begins with a review of the patient’s symptoms and medical history, followed by the collection of a midstream urine sample. This sample is immediately tested using a urinalysis to check for the presence of white blood cells (pyuria) and nitrites, which are strong indicators of a bacterial infection. If the urinalysis suggests an infection, the sample is sent for a urine culture to identify the causative bacteria and determine its susceptibility to antibiotics.
Treatment for an uncomplicated UTI involves a short course of oral antibiotics, usually lasting three to five days. First-line agents include nitrofurantoin, trimethoprim-sulfamethoxazole (TMP-SMX), or a single dose of fosfomycin, chosen based on resistance patterns and patient allergies. Patients must complete the entire course of medication, even if symptoms improve quickly, to ensure the infection is fully eradicated and prevent antibiotic resistance. To manage immediate discomfort, the OB/GYN may also prescribe a urinary analgesic like phenazopyridine, which helps reduce the painful burning sensation during urination.
Identifying When Specialist Referral is Necessary
There are specific circumstances in which an OB/GYN recommends a referral to a specialist, such as a Urologist or Nephrologist. This includes any case classified as a complicated UTI, which may involve structural abnormalities like kidney stones, the presence of an indwelling catheter, or underlying conditions like poorly controlled diabetes or immunosuppression. Pregnant patients with UTIs also require specialized management and follow-up.
Referral is necessary if the infection has spread to the upper urinary tract, leading to a condition called pyelonephritis. Symptoms such as high fever, chills, nausea, vomiting, or pain in the flank (where the kidneys are located) suggest kidney involvement and require more intensive treatment.
Patients experiencing recurrent UTIs, generally defined as three or more infections in 12 months or two in six months, require a specialized workup to identify any underlying causes or anatomical issues. In these situations, the specialist can perform advanced diagnostic procedures and recommend long-term prevention strategies.