Does a strong urinary smell mean you need treatment for an infection?

In rare cases a strong smell of urnie may be one of many signs of urinary tract infection, which mostly affects patients with chronic conditions, pregnant or  immunosuppressed etc., h

However, among younger and otherwise healthy women, such a smell is mostly a result of strong, concentrated urine.  Concentration and strong odor happens as the result of excessive sweating (hot weather, exercising etc.), dehydration or insufficient fluid intake.  In the absence of other symptoms, painful urination and fever, bacterial UTI is not likely.   Also, certain types of food can add to a strong odor of sulfur or ammonia - e.g. Asparagus, garlic and onion, beans and soy products and red meat.  Pungent smelling  relishes and spices such as curries may produce strong smelling urine. Multivitamins and supplements are also well known to add unusual odor to urine, and this is often mistaken for  “ UTI “. 

 All these products  must be considered and eliminated gradually to find the real cause of strong smelling urine, before taking antibiotics.  The common sense approach before taking medication is to perform urine analysis and a culture test.

What factors make you more likely to have a urinary tract infection if urine smells strong? 

It’s important to say that there is, of course, a large group of patients who really have a UTI. If woman is immunosuppressed, pregnant, or diabetic  she’s more likely to develop a UTI.  The presence of a tumor or stones obstructing  outflow of urine may lead to development of an infection. The age related increase of residual urine volume can contribute to chronic bacterial UTI among older women.

These patients present often with low grade fever and elevated WBC count . They often have a history of  ascending into kidneys infection (pyelonephritis).  In these cases, urine analysis has elevated the WBC, Leukocyte Esterase and Nitrites. If a patient has elevated temperature or positive history of pyelonephritis, aggressive antimicrobial therapy must be started at once. However if the above factors are absent and the urine culture is negative or contains only a small amount of Gramm positive germs, contamination by urethral or vulvar-vaginal secretion is more likely and antibiotics use cannot be justified unless the patient is immunosuppressed or pregnant, when the risk of serious complications is just too great.

Proper collection of a urine sample cannot be overemphasized and can help avoid unnecessary antibiotic use, which creates bacterial resistance and can backfire in case of real need. 


The information contained on this website is for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read on this website.

Leon Nitkin, M.D. I offer a full range of GYN services and limited obstetric care. I specialize in the provision of services for gynecological plastic, including narrowing of vagina and labia reduction; Cervical Cancer Immunizations (HPV Immunizations - GARDASIL) and have extensive experience in treatment of Uterine Fibroids - therapeutic and surgical. Our primary focus is your comfort with a female physician assistant on staff and a Board Certified Anesthesiologist for procedures.

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