The adherence to human uroepithelial cells of 23 Escherichia coli strains belonging to three groups with different levels of virulence was investigated, and the mechanism of adherence was studied. It was found that strains belonging to the most virulent group adhered better to human uroepithelial cells than did avirulent strains. Adherence of less virulent but supposedly nephropathogenic strains was more variable. These results suggest that adherence is an important virulence factor, especially in the group of strains with the highest but a more general virulence. Piliated strains adhered better than did nonpiliated strains. We found strong evidence for the existence of at least two different mechanisms of adherence: (i) mannose-sensitive adherence by piliated strains, very likely mediated by type I pili because this mannose-sensitive adherence was associated with mannose-sensitive hemagglutination of guinea pig erythrocytes by broth cultures of the strains; (ii) mannose-resistant adherence by piliated strains, very likely mediated by non-type I pili because this mannose-resistant adherence was invariably associated with mannose-resistant hemagglutination of human group A erythrocytes by the strains, whether grown in broth or on plates. Additionally, one strain without pili and without hemagglutinating activity adhered well. Thus in most cases adherence seemed to be mediated by bacterial pili, although different types might be involved.