Pyuria

What is pyuria?

Pyuria (pi-YER-ree-UH) is a condition in which you have high levels of white blood cells (leukocytes) or pus in your urine (pee). Pus is a thick, discolored (white, yellow, pink or green) fluid that your body makes to help fight off an infection. It consists of white blood cells, dead tissue and bacteria. You have pyuria if you have 10 or more white blood cells per cubic millimeter of pee.

Sterile pyuria is a type of pyuria in which you have white blood cells in your pee, but a healthcare provider can’t detect any bacteria.

Who does pyuria affect?

Anyone can get pyuria. However, you’re more likely to get pyuria if you:

• Are a woman or person assigned female at birth (AFAB).
• Are over 45.
• Have symptoms of menopause.

How common is pyuria?

Pyuria is common.

It may indicate the presence of many different health conditions, but it often appears alongside urinary tract infections (UTIs). UTIs are very common. Each year, 8 million to 10 million people receive treatment from a healthcare provider for a UTI.

Nearly 14% of women and people AFAB and 2.6% of men and people assigned male at birth (AMAB) have sterile pyuria. Sterile pyuria often appears as a result of a sexually transmitted disease or infection (STDs or STIs).

What does pyuria smell like?

If you have pyuria as symptom of a UTI, your pee may have a foul odor that smells like ammonia. Ammonia has a strong, distinct smell that can irritate the mucus membranes in your nose. You may be familiar with how ammonia smells — it’s an ingredient in many cleaning products.

What are the symptoms of pyuria?

The most common symptoms of pyuria include cloudy pee or pus in your pee.

If pyuria appears as a result of a UTI, your symptoms may include:

• Pain in your side (flank), abdomen or pelvic area.
• Pressure in your lower pelvis.
• Frequent need to pee (frequency).
• Sudden urges to pee (urgency).
• Incontinence (leaking pee).
• Pain while peeing (dysuria).
• Blood in your pee (hematuria).
• Fever.
• Nausea and vomiting.

What causes pyuria?

UTIs are the most common cause of pyuria. Other causes may include:

• STIs and STDs, including gonorrhea, human papillomavirus (HPV), syphilis and human immunodeficiency virus (HIV).
• Other viral infections, including adenovirus.
• Interstitial cystitis (painful bladder syndrome).
• Pneumonia.
• Tuberculosis.
• Sepsis.
• Kidney stones.
• Transvaginal surgical mesh.
• Organ transplant rejection.

Using certain types of medications may also cause pyuria, especially if taken over a long period of time. These medications include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin (Excedrin®), ibuprofen (Advil®) and naproxen sodium (Aleve®).
• Antibiotics that have penicillin or sulfa.
• Diuretics.
• Drugs that reduce the production of acid in your stomach (proton pump inhibitors).

Does pyuria indicate that I have a UTI?

UTIs are the most common cause of pyuria. However, if you have pyuria, it doesn’t necessarily mean that a UTI is the cause. Talk to a healthcare provider to determine the exact cause of your pyuria.

Is pyuria contagious?

No, pyuria by itself isn’t contagious. But, many of its causes are contagious, including STDs, STIs, adenoviruses and certain types of pneumonia.

How is pyuria diagnosed?

A healthcare provider can diagnose pyuria through a urinalysis (urine test).

During a urine test, you’ll pee into a special cup at a healthcare provider’s office. When you’re done, the provider will send your sample to a laboratory where a lab technician will use a microscope to check for white blood cells, bacteria and blood.

How is pyuria treated?

Pyuria treatment depends on its cause.

A healthcare provider will usually prescribe antibiotics to treat UTIs, bacterial STIs or tuberculosis. It’s important to finish your full course of antibiotics, even if you feel better. If you don’t, the cause of your pyuria can come back and become more difficult to treat.

If your pyuria doesn’t get better after you finish your full course of antibiotics, talk to your provider. Another condition may be the cause of your pyuria.

What happens if I don’t treat pyuria?

Untreated pyuria may — depending on the cause — lead to more serious conditions, such as blood poisoning (septicemia), kidney damage, organ failure and death.

Does cranberry juice help treat pyuria?

One popular theory is that cranberry juice may help treat or prevent UTIs that can cause pyuria. However, there isn’t enough research to definitely say that cranberry juice is an effective treatment. If you develop pyuria, you should discuss appropriate treatment options with your provider.

How can I prevent pyuria?

For most people, you can help prevent pyuria by preventing urinary tract infections. Tips to help prevent UTIs include:

• Practice good hygiene. For women and people AFAB, it’s important to wipe from front to back after peeing or having a bowel movement (pooping). People who menstruate should also regularly change their pads, tampons or other period hygiene products. It’s also a good idea to regularly wash the skin around your vagina and rectum with clean water and, if you’d like, a mild, unscented soap.
• Drink plenty of fluids. Drinking extra water and other fluids helps “flush out” bacteria from your urinary tract.
• Change your clothing. Wear loose clothing that keeps your genital area dry and helps prevent bacteria from growing in your urinary tract. Cotton underwear can also help absorb moisture, and underwear made out of synthetic materials helps wick away moisture.
• Pee after sex. Peeing after sex helps clear bacteria from your urinary tract.

You can also help prevent pyuria by protecting yourself from STIs. If you’re sexually active, the following tips can help prevent STIs that may lead to pyuria:

• Use condoms. Condoms help lower your risk of getting an STI by stopping or significantly reducing the exchange of bodily fluids.
• Get tested for STIs. Getting tested helps stop STIs from spreading to your sexual partners. It’s a good idea for you and any new sexual partner to get an STI test before having sex for the first time.
• Learn about STI symptoms. If you notice any STI symptoms, reach out to a healthcare provider right away.

What can I expect if I have pyuria?

Pyuria typically responds well to treatment. If you have pyuria symptoms, contact a healthcare provider quickly.

If your pyuria symptoms don’t clear up after treatment, talk to your healthcare provider. You may have a more serious condition that’s responsible for your pyuria. They may refer you to a specialist such as a urologist or a nephrologist (doctor who specializes in conditions that affect your kidneys).

When should I see a healthcare provider?

Call a healthcare provider as soon as you notice any changes in your pee or symptoms of a UTI or STI. If a provider diagnoses you with a UTI or STI and your symptoms get worse, reach out to the provider again. You may need a different treatment or you may have another condition.

What questions should I ask a healthcare provider?

• How do you know I have pyuria?
• If I don’t have pyuria, what other condition might I have?
• How did I get pyuria?
• What kind of treatment do you recommend?
• For how long and at what times of day should I take my medicine?
• How should I store my medicine?
• When will I start to feel better?
• Do I need to schedule a follow-up appointment?
• Should I see a urologist or a nephrologist?

What is the difference between pyuria and a UTI?

Pyuria is pus in your pee. It may cause your pee to look cloudy or discolored. Your pee may also smell. Pyuria is often a symptom of another condition, most commonly a urinary tract infection.

A UTI is a common type of infection in your urinary tract. The bacterium E. coli is the most common cause of UTIs.

A note from Cleveland Clinic

Pyuria is a condition in which there are white blood cells or pus in your pee. It can be surprising and concerning to notice your pee is cloudy or smells foul. If you notice any changes in your pee, talk to a healthcare provider. They can diagnose pyuria. Once they’ve determined its cause, they can work with you to get the most effective treatment.