When you’re UTI is actually an undiagnosed STI

Urinary symptoms are one of the most common reasons women seek care. Burning, urgency, frequency, pelvic discomfort, or the general sense that “something is off” often leads to an automatic assumption — both by women and by clinicians — that the problem must be a urinary tract infection.

But here is the truth.

A surprising number of women who are told they have a UTI are actually dealing with an undiagnosed or untested sexually transmitted infection.

This does not happen because women are doing anything wrong.

It happens because the way women are evaluated in many clinics is incomplete from the start.

Let’s break down why this happens and how it affects women’s health.

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Women’s Anatomy Makes STI Symptoms Look Like UTIs

The female urethra is short and positioned close to the vagina and cervix.

Because of this, inflammation or infection in the vagina, cervix, or urethra itself can create symptoms that feel identical to a UTI:

• burning
• urgency
• frequency
• pressure
• discomfort after sex
• pelvic irritation

This is especially common with infections such as:

• chlamydia
• gonorrhea
• trichomoniasis
• mycoplasma genitalium

All of these can irritate or inflame the tissues near the urethra, producing the exact same symptoms as a bladder infection.

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Many Clinics Diagnose UTIs by Symptoms Alone

In women, clinicians often use symptoms — not testing — to diagnose a UTI.

A woman says, “It burns when I pee,” and the diagnosis is made instantly.

What usually does not happen:

• a pelvic exam
• a vaginal or cervical swab
• testing for chlamydia or gonorrhea
• testing for trichomoniasis
• testing for mycoplasma genitalium
• confirming a bacterial UTI with a true culture

When clinicians skip these steps, two predictable issues arise:

1. STIs go untreated
2. Women receive antibiotics that do nothing for the real problem

Symptoms return. The cycle repeats.

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A “Clean” Urine Test Doesn’t Mean the Problem Was Checked

A woman may receive a urine test that comes back “clean,” and yet walk out no closer to an answer. A urine test only shows what is happening in the bladder. It does not check what is happening in the vagina, cervix, or urethra.

Here is the part almost no women are told:

Even when clinics run “STI testing,” they almost never check for the two infections most likely to mimic UTIs in women — Mycoplasma genitalium and trichomoniasis.

So a woman can be told:

• “Your urine is clear”
• “Your STI tests are negative”

…and still be carrying an infection causing burning, urgency, pelvic discomfort, or dysuria.

This is why so many women experience:

• recurring “UTIs”
• multiple negative urine tests
• antibiotics that do not help
• symptoms that come back
• months or years of frustration

The problem isn’t the woman.

The problem is that the right infections were never tested.

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Mycoplasma Genitalium Is a Major Cause of Urethral Symptoms in Women

Mycoplasma genitalium (Mgen) is frequently associated with:

• cervicitis
• urethritis
• pelvic discomfort
• persistent burning
• recurrent symptoms after “UTI treatment”
• ongoing inflammation of reproductive tissue

Women with Mgen often report UTI-like symptoms with repeatedly negative urine cultures.

Unless an Mgen test is ordered, the infection remains invisible.

Many clinics simply do not include this test — and women pay the price.

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Trichomoniasis Frequently Mimics UTIs in Women

Trichomoniasis affects women far more than men, and often presents with:

• burning
• irritation
• discomfort with urination
• vaginal inflammation
• symptoms that flare after sex

Because men are often asymptomatic carriers, women are the ones who feel the infection — especially around the urethral opening.

For some women, trich can smolder for months or years, creating ongoing inflammation. That inflammation increases susceptibility to other infections and may contribute to longer-term cervical changes.

Yet trichomoniasis is absent from many routine STI panels.

Women walk out with a “negative” test that never looked for the infection most likely to be causing their symptoms.

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UTI Antibiotics Do Not Treat Most STIs

When women with burning or urgency are given UTI antibiotics, they often don’t improve because the medication doesn’t treat the underlying infection.

Instead of resolving symptoms, women may experience:

• persistent discomfort
• repeated courses of antibiotics
• missed infections
• long-term inflammation
• worsening symptoms over time

A “UTI” that doesn’t respond to treatment is often not a UTI at all.

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The Bottom Line

Many women who are told they have UTIs actually have untested STIs that mimic urinary symptoms.