Are Viruses a Cause of Urinary Tract Infections? A Narrative Review

Urinary tract infections (UTIs), often associated with the lower urinary tract, are a major public health problem. Traditionally, urine has been believed to be sterile in healthy individuals, but increasing evidence shows that the urinary tract may contain a variety of viruses even in healthy populations. Bacteria remain the major etiologic agents of UTIs, but growing evidence points to viruses as emerging causes. This narrative review focuses on six viruses: adenoviruses, cytomegalovirus (CMV), BK virus (human polyomavirus), severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2), Zika virus, and West Nile virus. West Nile virus has been detected in urine without clear evidence of causing UTIs; however, the other five viruses reviewed in this narrative discussed have been associated with UTIs and may lead to various complications. Management of viral UTIs is mainly supportive, with reduced immunosuppression, symptom alleviation, prevention of complications, and monitoring of response to therapy. Key interventions include managing secondary bacterial infections, ensuring adequate hydration, using analgesics for pain and discomfort, and closely monitoring for treatment failure or recurrence. Effective prevention and control of viral infections also rely on broader public health strategies, including vaccination, sanitation, surveillance, early diagnosis, and appropriate treatment. Additional approaches may include prophylaxis, preemptive therapy, virus-specific treatments, and donor–recipient serostatus matching. Regular monitoring and careful adjustment of immunosuppressive therapy are also important, as no effective vaccine is available except for Ad4/Ad7 and SARS-CoV-2, and definitive preventive strategies are currently unavailable. Future research should focus on developing safe and effective antivirals and vaccines to prevent and treat viral UTIs and their complications.