Pyuria Diagnosis and Treatment

Pyuria is a condition that occurs when excess white blood cells are present in the urine.

Urine sample on table in doctor's office
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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.

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