Rarely there is blood in the urine. If the infection has spread to the kidneys, there will be fever, chills, and flank pain which mandates immediate evaluation. Infections without fever usually responds to a 1 to 3 day course of antibiotics but relapsing infection may need 2-6 weeks of treatment. In men, urine collection can be followed by massage of the prostate by a physician's finger in the rectum. A ten-fold increase in bacteria grown in voided urine indicates a possible reinfection focus in the prostate.
Culture is expensive and time-consuming.
A special stain inveted by Dr. Gram can be useful. Medicines used are sulfonamide with or without trimethoprim, furadantin, ampicillin, or the fluoroquinolones. In the presence of a bladder stone, the infection is almost certain to recur. Relief of symptoms by antibiotic does not indicate cure. The important part of treatment is to re-evaluate the patient 10 to 14 days later for cure.