Pyuria and Sterile Pyuria: Causes and Treatments

Cheryl Whitten
Cheryl Whitten
March 11, 2024
4
min read
Medically reviewed by:
Trager Hintze, PharmD
Pyuria and Sterile Pyuria: Causes and Treatments
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Sterile pyuria is a common condition that affects 13.9% of women and 2.6% of men [1]. Women with certain conditions are more likely to develop pyuria [1]. Here’s what you need to know. 

What Is Pyuria?

Pyuria is the presence of pus in the urine, typically with high levels of white blood cells known as leukocytes [2]. High white blood cell counts often appear with other findings such as pyuria and bacteriuria (bacteria in the urine) and pyuria and hematuria (or blood in the urine) [3]. 

Another type of pyuria, called sterile pyuria, is the presence of high levels of white blood cells without bacteria or tissue. The typical measurement for pyuria is 10 or more white blood cells per cubic millimeter of urine with or without bacteria [2]. 

What Causes Pyuria?

Pyuria, often found in many different conditions, usually means there's an infection. It commonly happens in urinary infections and some diseases like kidney and sexually transmitted infections such as chlamydia

Pyuria is a common finding of many different conditions. However, it is typically a sign of infection and most commonly happens in urinary tract infections and sexually transmitted infections or diseases [3]. These include [3]:

  • Kidney infections
  • Bladder infections
  • Kidney stones
  • Chlamydia
  • Gonorrhea
  • HIV
  • Syphilis
  • HPV

It may also occur with pneumonia, tuberculosis, or an adenovirus or flu-like infection [2]. Sterile pyuria may also appear in conditions that cause kidney injury or inflammation, such as [4, 5]:

  • System lupus erythematosus or lupus, an autoimmune disease
  • Kawasaki disease, or inflammation of blood vessels
  • Chronic kidney disease

Pyuria is also a common side effect of long-term use of some more ordinary devices or medications such as [4]:

  • Catheters
  • Antibiotics
  • Diuretics
  • Non-steroidal anti-inflammatory drugs, such as ibuprofen

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Symptoms of Pyuria

Pyuria may appear with or without bacteria and with or without symptoms. While white blood cells are a sign of inflammation, this finding doesn’t always mean you have an infection [6]. In addition, bacteria grow in some cases without causing illness, such as when you have a catheter [6]. 

However, you may have signs of a UTI with pyuria, which include [2]:

  • Burning or pain during urination
  • Frequent urination
  • Urge to urinate
  • Hesitancy or trouble urinating
  • Back or side pain
  • Fever
  • Chills
  • Bloody urine
  • Cloudy urine

Best Treatments for Pyuria and Sterile Pyuria

Pyuria doesn’t always need treatment. Some people may have higher than normal white blood cell counts in the urine with high amounts of bacteria but no symptoms [7]. In these cases, it’s not an infection and doesn’t need treatment [7]. Instead, you can usually monitor your urine using a urinalysis test and watch for changes in your health and how you feel [2]. 

However, if symptoms appear, your healthcare provider will do additional testing or exams to identify the cause and prescribe medications. The specific treatment will vary, depending on the cause, but may include [1]:

  • Antibiotics
  • Antivirals
  • Antifungals
  • Catheter removal 

Monitor Urinary Health With Diagnox

Pyuria is a sign of inflammation and infection but doesn’t always cause symptoms and may not need treatment. However, you can keep tabs on your urinary health at home with an at-home urinalysis test from Diagnox. 

Check for white blood cells, nitrites (bacteria), pH levels, blood, and other parameters from the comfort and privacy of your home. Talk to your healthcare provider if you have positive tests and symptoms. Order at-home urinalysis tests for fast and accurate results and control over your health and wellness.

References

[1] G. Wise and P. Schlegel, “Sterile Pyuria,” The New England Journal of Medicine, vol 372, no 11, 2015. [Accessed March 4, 2024}.

[2] Cleveland Clinic Staff, “Pyuria,” Cleveland Clinic. [Accessed March 4, 2024].

[3] R. Mazhari and P. Kimmel, “Hematuria: An algorithmic approach to finding the cause,” Cleveland Clinic Journal, vol 6, no 11, 2002. [Accessed March 4, 2024].

[4] P. Glen, A. Prashar and A. Hawary, “Sterile pyuria: a practical management guide,” The British Journal of General Practice vol 66, no 644, 2016. [Accessed March 4, 2024].

[5] I, Kuo, J. Lee and D Hwang, “Pyuria, urinary tract infection and renal outcome in patients with chronic kidney disease stage 3–5,” Scientific Reports, vol 10, no 19460, 2020. [Accessed March 4, 2024].

[6] A. Sabih and S. Leslie, “Complicated Urinary Tract Infections,” StatPearls, StatPearls Publishing, Treasure Island, FL, 2024. [Accessed March 4, 2024]

[7] A. Zuger, “Pyuria Doesn’t Necessarily Indicate Infection,” NEJM Journal Watch, 2023. [Accessed March 4, 2024].

About the Author
Cheryl Whitten

Cheryl Whitten is a health writer with a background in allied health care as an herbalist and clinical aromatherapist. She holds a Bachelor of Arts in English literature from Athabasca University and certificates from the University of Maryland and Wild Rose College. She writes for leading health and lifestyle websites with a focus on health, wellness, and consumer products.

About the Reviewer
This blog was
Medically reviewed by:
Trager Hintze, PharmD

Trager Hintze is a clinical assistant professor and emergency medicine clinical pharmacist located in College Station, Texas. He has a bachelor's degree in biology as well as a Doctor of Pharmacy degree. He balances teaching at Texas A&M University College of Pharmacy and practicing emergency medicine at St. Joseph Regional Health Hospital.

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