Definition
Pyuria is a condition that occurs when excess white blood cells, or pus, are present in the urine. Pyuria causes cloudy urine and 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. Some people may experience sterile pyuria in which white blood cells are present in the urine, but there are no bacteria or microorganisms. Sterile pyuria is often caused by a sexually transmitted disease or medications.
WBC in urine
Epidemiology
Pyuria due to a urinary tract infection is common in people of all ages but is more prevalent in females than males. The overall prevalence of asymptomatic infection is estimated to be 3.5%. Risk factors for this include diabetes, UTI history, and lower socioeconomic status. Pregnant women are also more likely to be affected, with 4-10% women found to have pyuria.
Causes
A UTI is the most common cause of pyuria, as bacteria in the urinary tract can lead to pus being excreted out in your urine. Other causes of pyuria include:
- STDs, such as chlamydia, gonorrhea, genital herpes, syphilis, and HIV
- Viral infections
- Interstitial cystitis
- Painful bladder syndrome
- Pelvic infections
- Intra-abdominal infections
- Pneumonia
- Sepsis
- Radiation cystitis
- Foreign bodies in the urinary tract
- Urinary fistulas
- Intrinsic renal diseases
- Renal transplant rejection
- Polycystic kidney disease
- Fungal infections
Experiencing pus in your urine can also be the result of long-term use of the following medications.
- Antibiotics with penicillin
- Aspirin
- Diuretics
- Olsalazine
- Nitrofurantoin
- Non-steroidal noninflammatory drugs, such as ibuprofen (Advil, Motrin)
- Proton pump inhibitors
Risk factors of Pyuria
As mentioned previously, by far the most prevalent cause of pyuria is a bacterial infection of the urinary tract. However, there are several health conditions that may be responsible for causing pyuria. These may include:
- Infections
- Kidney disease
- Papillary necrosis
- Diabetes
- Tuberculosis
- Renal stones
- Kawasaki disease
- Prostate cancer
- Menopause is another factor that can increase the risk for pyuria in women because of the higher risk for UTIs in menopause.
Symptoms
Symptoms of a UTI may include:
- Frequent urination
- Blood in the urine
- Cloudy urine
- Burning sensations during urination
Pyuria not caused by a UTI can share similar symptoms. You may notice:
- Bladder pain
- Nausea or vomiting, which may be a sign of kidney problems
- Cloudy urine
- Discharge
- Abdominal pain
- Fever and chills
Complications of Pyuria
- Untreated infections can develop into blood poisoning and even organ failure. If a urinary tract infection is not treated with the appropriate medication, permanent kidney damage is a real possibility.
- In the bladder infection, possible complications are the progression of upper urinary tract infection of the ureter and kidney.
- In kidney infection, the generalized infection that is sepsis or kidney damage can occur as a result of the infection.
Diagnosis and Test
- Urinalysis: initial test to identify likely infection but a urine sample needs to be sent to the laboratory. See the separate article on Urine Dipstick Analysis. Positive nitrite test +/- positive leukocyte esterase test. Haematuria and proteinuria occur in UTI but are also present in other conditions.
- Urine microscopy, culture, and sensitivities; ask the laboratory to culture under conditions allowing identification of fastidious or slow-growing organisms.
- Consider the possibility of sexually transmitted disease; take a sexual history and consider sending swabs for chlamydia and N. gonorrhea.
- Polymerase chain reaction (PCR) testing of sterile pyuria has been recommended for the detection of Chlamydia trachomatis, mycoplasma and ureaplasma infections.[4]
- Always consider tuberculosis; culture for AFBs (three early morning urine samples).
- With urine obtained directly from the bladder, any organism grown is significant and should be treated with a prolonged course of appropriate antibiotics.
- Cystoscopy may be required to exclude non-infective causes.
- Other diagnostic tests may include MRI, CT scan, ultrasound, and intravenous pyelogram.
Management of Pyuria
The recommended treatment for pyuria is dependent on the underlying cause of the condition. If there is no associated infection and the patient is asymptomatic, there may not be a need for any treatment.
Several antibiotic medications may be indicated to eradicate bacteria in the urinary tract. These may include:
- Levofloxacin
- Ciprofloxacin
- Minocycline
- Ampicillin
- Amoxicillin/Clavulanate
- Erythromycin
- Doxycycline
- Norfloxacin
Home remedies
Here are some quick and easy home remedies to get rid of pus in the urine.
Cranberry juice
Cranberry juice is acidic in nature. This makes it difficult for the bacteria to survive in the urinary tract. Also, it prevents bacteria from adhering to the walls of the track. Drink 400 ml unsweetened cranberry juice daily so that faster results are observed, as less sugar content makes it more acidic.
Water
The simplest way to fight this infection is to drink plenty of water throughout the day. More water will help wash out the bacteria from the track making it free from infection. Also, it will dilute the urine reducing the pain it produces during urinating.
Uva ursi
It is a popular antiseptic herb. Uva Ursi or Bearberry helps in getting rid of the infection, thereby reducing the pus in the urine. This herb can be consumed in tea or capsule form so as to treat UTIs.
Goldenseal
Known to treat Chlamydia, this herb is very useful in treating pus in urine if the reason for it is Chlamydia. It also stimulates the immune system and prevents the body from forming pus. This herb is available in the form of capsules. Consume 1-2 capsules daily to get rid of pus in the urine.
No Douching
If you have pus in urine due to any sexually transmitted disease, then remember not to dough your vagina. This will disturb the pH balance of the vagina and cause infections to grow.
Garlic
Garlic has antibiotic properties that make it useful in fighting against Chlamydia. It is one of the important anti-viral herbs to treat many ailments. You can add garlic to your daily food or also consume it in raw form.
Cucumber juice
It is useful for treating pus in the urine. It increases the amount of urine that is thrown out of the body and thus washes out the bacteria. Extract juice of cucumber and consume 25 ml of it thrice a day to get rid of such infections.
Cinnamon
If you have pus in urine, then surely you will experience pain while urinating. Cinnamon seeds help in reducing this pain. Mix 2 grams of cinnamon powder in a glass full of water and drink it.
Coriander seeds
Soak 10 grams of coriander seeds in water for a night. Next morning, grind these seeds along with water and drink it together with sugar candy. This will effectively reduce the infections.
Prevention and cure
- Use of condoms during sex reduces the risk of getting affected by STDs, thereby reducing any further complications.
- Wash or shower before and after having a sexual intercourse.
- Plenty of water: Always keep yourself hydrated in order to produce the right amount of urine. If less urine is produced, it is highly concentrated, which increases the risk.
- Do not control the urge to urinate as it leads to a growth of harmful bacteria in the tract.
- If you have a doubt about developing an infection, it is very good to avoid coffee and spicy foods.
- For those who require the use of indwelling catheters, observe sterile technique while performing the procedure.