Pyuria Diagnosis and Treatment

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

Pyuria Symptoms

With pyuria, you can have visible changes in the urine, which may appear cloudy or thick or look like pus. Sometimes these are the only symptoms.

Pyuria is often an indication of a urinary tract infection (UTI). A UTI can cause urinary frequency, burning with urination, and urinary urgency (a sense that you absolutely have to go).

Pyuria can also be an indication of sepsis, a life-threatening reaction to a blood infection that causes a fever, lethargy, changes in blood pressure, a weak pulse, and trouble breathing.

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 their lifetime. Some women 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 shorter and closer to the anus, as compared to men.

Men 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, enlarged prostate with 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).

With sterile pyuria, the urine contains white blood cells but appears sterile. This means that the culture doesn't grow bacteria and other microorganisms.

Causes of sterile pyuria:

• Sterile pyuria is typically caused by sexually transmitted infections (STDs), 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 sterile and non-sterile forms of pyuria can be diagnosed with a urinalysis. The urine is sent for microscopic evaluation. Pyuria is diagnosed when there are 10 white blood cells per cubic millimeter of centrifuged urine.

Urine testing 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 healthcare provider may order blood tests or imaging tests to look for other conditions that could be causing it, like kidney stones.

If you are taking medications that can cause pyuria, your healthcare provider may ask you to stop them, which can help determine whether medications are the cause.

Treatment

The treatment for pyuria depends on the cause. 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 your urinary tract infection may return. Your healthcare provider 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. It's important to gently wash the skin around and between the vagina and rectum, preferably with regular showers rather than baths.

Washing, or showering, both before and after sexual activity may also lower your risk of getting a urinary tract infection. And take precautions to avoid STDs by using condoms, if you are at risk of exposure to these contagious infections.

Staying hydrated can help prevent UTIs and kidney stones.