Streptococcus agalactiae causes approximately 160,000 cases of urinary tract infection (UTI) in the United States annually, encompassing various forms of infection including cystitis and asymptomatic bacteriuria (ABU). The host-pathogen interactions that occur during S. agalactiae UTI and mechanisms of pathogenesis are not well defined. In this presentation, I will give an overview of the interactions between bladder cells, bladder tissue and uropathogenic S. agalactiae (UPSA) that contribute to acute disease, and the host responses to infection. Recent insights on infection-induced cytotoxicity and the contributions of virulence factors, including β-hemolysin/cytolysin (β-H/C), caspule, and the global virulence regulator CovR will be discussed. Finally, I will discuss ABU-causing S. agalactiae (ABSA) strains and how these strains might colonize the urinary tract via utilization of urine to support growth. Overall, this presentation will provide an update on the pathogenesis of streptococcus urinary tract infection.