Urological Health Pyuria Diagnosis and Treatment By Tracee Cornforth linkedin Tracee Cornforth is a freelance writer who covers menstruation, menstrual disorders, and other women's health issues. Learn about our editorial process Tracee Cornforth Medically reviewed by Medically reviewed by Jamin Brahmbhatt, MD on July 20, 2020 facebook linkedin Jamin Brahmbhatt, MD, is board-certified in urology. He is an assistant professor at UCF College of Medicine and chief of surgery at Orlando Health South Lake Hospital. Learn about our Medical Review Board Jamin Brahmbhatt, MD on July 20, 2020 Print Table of Contents View All Table of Contents Symptoms Causes Diagnosis Treatment Prevention Pyuria is a condition that occurs when excess white blood cells are present in the urine. Karen D'Silva / The Image Bank / Getty Images Pyuria Symptoms Pyuria frequently indicates the presence of a urinary tract infection (UTI). Pyuria can also indicate sepsis, a life-threatening bacterial infection, or pneumonia in older adults. There may be visible changes in the urine, which may appear cloudy or thick or look like pus. If your urine appears thick or cloudy after multiple trips to the bathroom throughout the day, make an appointment with your doctor to have a urinalysis. Causes Urinary tract infections are the most common cause of pyuria. Although most UTIs are not serious, they are painful. About half of all women will have at least one urinary tract infection in her lifetime. Some women will go on to have recurrent urinary tract infections. The most common cause of urinary tract infections is bacteria from the bowels that migrates to the urethra. Women are more likely to get urinary tract infections because their urethra is closer to their anus, as compared to men. Men also have longer urethras, making it harder for bacteria to make their way up to the bladder. Since men are less likely to get urinary tract infections, when they do get one, it should be taken seriously. Causes of infections in men can include prostatitis, incomplete bladder emptying, and bladder or kidney stones. Sterile Pyuria Pyuria can be non-sterile (caused by bacteria) or sterile (not caused by a specific bacteria). In addition to pyuria due to infection, you can also have sterile pyuria—urine that contains white blood cells but still appears sterile, free from bacteria and microorganisms, based on culturing techniques. Sterile pyuria is typically caused by sexually transmitted infections, such as gonorrhea, or viruses. It can also be the result of a reaction to medications (like acetaminophen) or other conditions like Kawasaki disease and genitourinary tuberculosis. Parasites, kidney stones, tumors and cysts, and interstitial cystitis can also lead to sterile pyuria. Diagnosis Both forms of pyuria can be determined from a urinalysis. It cannot be diagnosed on an office dipstick urine test. Instead, the urine is sent for microscopic evaluation. Pyuria is diagnosed when there are 10 white blood cells per cubic millimeter of centrifuged urine. Testing of the urine will also be able to detect any bacteria that may be present. If your pyuria is not the result of a bacterial infection, more testing may be needed to determine the cause. Your doctor may order blood tests or imaging tests to rule out other conditions. If you are taking medications that can cause pyuria, your doctor may ask you to stop them, ruling your medications out as a cause. Treatment The way in which pyuria is treated depends on how it was caused. Most cases are caused by UTIs, which are treated with antibiotics. In most cases, antibiotic treatment will relieve the symptoms of a UTI. You must take all the antibiotics prescribed or risk your urinary tract infection returning. Your doctor may ask you to return for a follow-up urinalysis after you complete antibiotic treatment to make sure the infection is completely gone. Prevention Practicing good personal hygiene can help prevent urinary tract infections. This includes always wiping from front to back after urination and bowel movements, as well as daily washing of the skin around and between the vagina and rectum. Washing, or showering, both before and after sexual activity may also lower your risk of getting a urinary tract infection. Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Goonewardene S, Persad R. Sterile pyuria: a forgotten entity. Ther Adv Urol. 2015;7(5):295-298. doi:10.1177/1756287215592570 Rowe TA, Juthani-Mehta M. Diagnosis and Management of Urinary Tract Infection in Older Adults. Infect Dis Clin North Am. 2014;28(1):75-89. doi:10.1016/j.idc.2013.10.004 Jhang JF, Kuo HC. Recent advances in recurrent urinary tract infection from pathogenesis and biomarkers to prevention. Ci Ji Yi Xue Za Zhi. 2017;29(3):131-137. doi:10.4103/tcmj.tcmj_53_17 Minardi D, D'Anzeo G, Cantoro D, Conti A, Muzzonigro G. Urinary tract infections in women: etiology and treatment options. Int J Gen Med. 2011;4:333-343. doi:10.2147/IJGM.S11767 Watanabe T. Pyuria in patients with Kawasaki disease. World J Clin Pediatr. 2015;4(2):25-29. doi:10.5409/wjcp.v4.i2.25 Additional Reading Urinary Tract Infection. Medline Plus Wise, Gilbert, Schlegel, Peter; Sterile Pyuria, New England Journal of Medicine, March 2015