Pyuria resident survival guide
Synonyms and keywords: Approach to pyuria, Pyuria workup, Pyuria management

# Overview
Pyuria is a urinary condition characterized by a high number of white blood cells in the urine. It is generally characterized as the presence of 10 or more white blood cells per cubic millimetre in a sample of urine, 3 or more white cells per high-power field of unspun urine, a positive result on Gram's staining of an unspun urine specimen or a urinary dipstick test that is positive for leukocyte esterase. Pyuria occurs in urinary tract infections (UTI) and/or sepsis. Other causes include sterile pyuria, STDs, pneumonia, interstitial cystitis, kidney stones, pelvic infections and urinary fistulas. Long-term usage of some medications, including aspirin, diuretics, nitrofurantoin, proton pump inhibitors and NSAIDs, induces pyuria. There may be visible changes in the urine, which may appear cloudy or thick or look like pus.

# Causes

## Life Threatening Causes
Life-threatening causes of pyuria include
- Sepsis

## Common Causes
- Sterile Pyuria
Sexually transmitted disease such as chlamydia, gonorrhea, genital herpes, human papilloma virus infection, syphilis and HIV
Viral Infections such as adenovirus, BK polyomavirus, and cytomegalovirus
Genitourinary tuberculosis
Fungal infection such as Candida albicans
Parasitic infection such as Trichomonas vaginalis
- Sexually transmitted disease such as chlamydia, gonorrhea, genital herpes, human papilloma virus infection, syphilis and HIV
- Viral Infections such as adenovirus, BK polyomavirus, and cytomegalovirus
- Genitourinary tuberculosis
- Fungal infection such as Candida albicans
- Parasitic infection such as Trichomonas vaginalis
- Interstitial cystitis
- Painful bladder syndrome
- Pelvic infections
- Intra-abdominal infections
- Radiation cystitis
- Pneumonia
- Foreign bodies in the urinary tract
- Transvaginal mesh
- Urinary fistulas
- Intrinsic renal diseases
- Renal transplant rejection
- Polycystic kidney disease
- Kidney stones
- Autoimmune diseases, such as Kawasaki disease
The table below demonstrates the possible causes of pyuria:

# Diagnosis
The below algorithms shows primary approach to patients with pyuria:
Shown below is an algorithm summarizing the diagnosis of pyuria.

# Treatment
Shown below are the algorithms summarizing the treatment of pyuria.
It typically depends on the specific cause of pyuria.
Abbreviations: NAAT: Nucleic Acid Amplification Test

# Do's
Evaluate for sexually transmitted diseases, if risk factors are present including unprotected sexual encounters.
Instruct the female patients to:
- Lose weight (if they are overweight or obese).
- Always stay hydrated.
- Urinate after sexual intercourse.
- Always wipe front to back.
- Wear cotton/comfortable underwear.
- Use menstrual cups, sanitary pads, or clean period-proof underwear.
- Maintain personal hygiene.

# Don'ts
- Do not give fluoroquinolones in pregnancy.
- Don't give TMP-SMX in the first trimester or near term of pregnancy.
- Delay urination.
- Smoke
- Drink the following items in excess:
Caffeinated sodas
Alcohol
Spicy foods
Acidic fruits
- Caffeinated sodas
- Alcohol
- Spicy foods
- Acidic fruits