Urinary tract infections, commonly known as UTIs, are among the most frequent reasons Americans seek medical care. Millions of patients visit urgent care centers, primary care offices, or emergency rooms every year due to painful and disruptive urinary symptoms. In recent years, however, the way UTIs are diagnosed and treated has changed dramatically.
With the rapid expansion of telehealth services, many patients now receive UTI treatment through online questionnaires, video visits, or messaging platforms. While this convenience has removed major barriers to care, experts warn that it has also created new risks, including unnecessary antibiotic use, missed diagnoses, and the growing threat of antibiotic resistance.
To address these challenges, researchers from the VA Ann Arbor Healthcare System and the University of Michigan have released a new evidence based national guide designed to improve how suspected UTIs are evaluated and treated, especially in virtual care settings. The guide was published on January 29, 2026 in JAMA Network Open and is already being piloted in Veterans Affairs hospitals across the country.
UTIs are incredibly common, particularly among women, older adults, and individuals with certain chronic conditions. Symptoms often include painful urination, frequent urges to urinate, pelvic discomfort, and cloudy or foul smelling urine. Because these symptoms are uncomfortable and disruptive, many patients seek quick treatment, often expecting antibiotics.
Dr. Jennifer Meddings, lead author of the new guide and a primary care physician at the Ann Arbor VA, emphasizes that UTIs are one of the most common reasons antibiotics are prescribed in the United States. At the same time, antibiotic resistant bacteria are becoming increasingly widespread.
The problem is not simply overprescribing antibiotics. It is also about prescribing the wrong antibiotics, prescribing them without proper testing, or treating symptoms that may not be caused by a bacterial infection at all.
Telehealth has transformed access to care. Patients can now receive medical advice without taking time off work, arranging transportation, or sitting in waiting rooms. For people in rural areas, caregivers, and those with mobility limitations, virtual care can be life changing.
However, when it comes to UTIs, telehealth introduces unique challenges.
In traditional in person visits, clinicians can collect urine samples for dipstick tests and urine cultures. These tests help confirm whether bacteria are present and identify which antibiotics are most effective. In virtual visits, providers often rely solely on patient reported symptoms.
In some cases, patients receive antibiotics after filling out an online questionnaire, with no urine testing performed at all. While this may be appropriate in certain situations, it can also lead to misdiagnosis and unnecessary antibiotic exposure.
Antibiotics are powerful tools, but they are not harmless. Overuse contributes to the development of drug resistant bacteria, sometimes referred to as superbugs. These resistant infections are harder to treat, require stronger medications, and increase the risk of complications.
In addition, antibiotics can cause side effects such as nausea, diarrhea, allergic reactions, and yeast infections. They can also disrupt the normal balance of bacteria in the body.
Another concern is that not all urinary symptoms are caused by UTIs. Conditions such as bladder irritation, sexually transmitted infections, kidney stones, or even early signs of sepsis can mimic UTI symptoms. Treating these conditions with antibiotics alone may delay proper diagnosis and care.
The newly released Ann Arbor Guide to Triaging Adults with Suspected UTI was developed to help clinicians navigate these complexities. It provides two clear, step by step decision tools.
One tool is designed for non pregnant women. The other is tailored for men, who often require different evaluation due to higher risk of complications.
The guide helps clinicians determine when urine testing is necessary, when antibiotics can be safely prescribed without testing, and when further evaluation is needed.
One of the key messages of the guide is that not every patient with urinary symptoms needs immediate antibiotics. Instead, care should be individualized based on symptoms, medical history, and risk factors.
The guide encourages urine cultures whenever possible, particularly for patients who experience frequent UTIs or have complicating conditions. Urine cultures provide valuable information that simple dipstick tests or at home kits cannot reliably offer.
Researchers also caution against relying on over the counter UTI tests sold online or in stores. These tests often lack accuracy and can produce false positive results, leading patients to believe they have an infection when they do not.
The guide goes beyond straightforward cases and addresses more complex scenarios. This includes patients who have undergone organ transplants, are receiving chemotherapy, have chronic kidney disease, or experience recurrent UTIs.
It also helps clinicians recognize red flag symptoms that may indicate a more serious condition, such as a kidney infection or sepsis. Symptoms like fever, back pain, confusion, or low blood pressure require urgent evaluation and should not be managed solely through virtual care.
Importantly, the guide acknowledges that telehealth plays a vital role in modern healthcare. It does not recommend eliminating virtual care for UTIs. Instead, it provides guidance on when antibiotics may be prescribed without testing, such as when patients live far from a laboratory or cannot travel within a few days.
This balanced approach recognizes real world barriers while still prioritizing patient safety and responsible antibiotic use.
Dr. Meddings notes that while virtual care makes it easier to access treatment, questionnaires alone may not be sufficient to ensure the correct diagnosis or therapy in every case.
Veterans Affairs hospitals are already piloting the guide during telehealth visits, allowing researchers to study how it affects prescribing patterns, patient outcomes, and antibiotic resistance trends.
If widely adopted, the guide could help standardize UTI care across in person and virtual settings, reduce unnecessary antibiotic use, and improve diagnostic accuracy.
For patients, this may mean fewer side effects, better targeted treatments, and reduced risk of serious complications.
Patients using telehealth services for UTI symptoms should understand that faster access does not always mean better care. Providing accurate symptom information, reporting prior UTIs, and following recommendations for testing when advised are all important steps.
Patients should also be cautious about self diagnosing UTIs using at home tests or assuming antibiotics are always required. If symptoms worsen, do not improve, or include fever or back pain, in person evaluation may be necessary.
The release of this guide reflects a broader effort known as antibiotic stewardship. This approach aims to use antibiotics only when truly necessary and to choose the right drug, dose, and duration.
As antibiotic resistance continues to rise globally, responsible prescribing is no longer optional. It is essential for protecting current and future patients.
Telehealth is here to stay. Tools like the Ann Arbor UTI guide help ensure that convenience does not come at the cost of safety or quality.
UTIs remain a common and frustrating health issue for millions of Americans. While telehealth has improved access to care, it has also highlighted the need for clearer guidance and more consistent practices.
The new national guide developed by researchers at the University of Michigan and the VA Ann Arbor Healthcare System offers a practical, evidence based framework for diagnosing and treating suspected UTIs in both virtual and in person settings.
By encouraging appropriate testing, thoughtful antibiotic use, and awareness of high risk situations, the guide has the potential to improve patient outcomes while addressing the growing challenge of antibiotic resistance.
As healthcare continues to evolve, balanced approaches like this will be critical to delivering safe, effective, and accessible care.
Michigan Medicine, University of Michigan. News release dated January 28, 2026.
This article is for informational and educational purposes only and does not constitute medical advice, diagnosis, or treatment. Statistical data and medical guidelines reflect general trends and may not apply to individual circumstances. Always seek the advice of a qualified healthcare provider with any questions regarding medical conditions or treatment decisions.
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