{"id":5219,"date":"2022-07-07T15:00:00","date_gmt":"2022-07-07T08:00:00","guid":{"rendered":"https:\/\/drsoaraweeurology.com\/?p=5219"},"modified":"2026-08-25T02:22:47","modified_gmt":"2026-08-24T19:22:47","slug":"%e1%80%99%e1%80%bc%e1%80%af%e1%80%b6-pyuria-%e1%80%a1%e1%80%91%e1%80%bd%e1%80%b1%e1%80%91%e1%80%bd%e1%80%b1%e1%80%a1%e1%80%9a%e1%80%b0%e1%80%a1%e1%80%86","status":"publish","type":"post","link":"https:\/\/drsoaraweeurology.com\/my\/2022\/07\/07\/sterile-pyuria-general-ideas\/","title":{"rendered":"White Cells in the Urine With a Negative Culture: What Sterile Pyuria Actually Means"},"content":{"rendered":"\n<div class=\"wp-block-columns coblocks-author-columns has-background is-layout-flex wp-container-core-columns-is-layout-52275889 wp-block-columns-is-layout-flex\" style=\"background-color:#8C8C971A;padding-top:2.5rem;padding-right:2.5rem;padding-bottom:2.5rem;padding-left:2.5rem\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" 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The culture grows nothing. Another antibiotic is prescribed, the pattern repeats, and both patient and doctor become frustrated. This is sterile pyuria, and the frustration usually comes from treating it as a stubborn urinary infection when it is a signal to look somewhere else entirely.<\/p>\n\n\n<script type=\"application\/ld+json\">\r\n{\r\n  \"@context\": \"https:\/\/schema.org\",\r\n  \"@type\": \"FAQPage\",\r\n  \"mainEntity\": [\r\n    {\r\n      \"@type\": \"Question\",\r\n      \"name\": \"What is sterile pyuria?\",\r\n      \"acceptedAnswer\": {\r\n        \"@type\": \"Answer\",\r\n        \"text\": \"Sterile pyuria is a condition where white blood cells (more than 2 WBC per high power field) are detected in a urine test, indicating inflammation, but the urine culture shows no bacterial growth. It means there is urinary tract inflammation without a confirmed bacterial infection.\"\r\n      }\r\n    },\r\n    {\r\n      \"@type\": \"Question\",\r\n      \"name\": \"What are the infectious causes of sterile pyuria?\",\r\n      \"acceptedAnswer\": {\r\n        \"@type\": \"Answer\",\r\n        \"text\": \"Infectious causes include recent antibiotic use within 2 weeks that suppresses bacterial growth in the urine culture (causing a false negative result), and non-bacterial infections such as parasites, viruses, or tuberculosis affecting the urinary tract.\"\r\n      }\r\n    },\r\n    {\r\n      \"@type\": \"Question\",\r\n      \"name\": \"What are the non-infectious causes of sterile pyuria?\",\r\n      \"acceptedAnswer\": {\r\n        \"@type\": \"Answer\",\r\n        \"text\": \"Non-infectious causes include urinary tract malignancy (suggested by significant weight loss), prior urologic procedures or pelvic radiation, urinary tract stones or kidney disease (if red blood cells are also found), systemic conditions such as pregnancy, diabetes, severe hypertension, post-menopausal state, SLE, or bladder pain syndrome, and certain medications including NSAIDs, steroids, penicillin, and proton pump inhibitors.\"\r\n      }\r\n    },\r\n    {\r\n      \"@type\": \"Question\",\r\n      \"name\": \"Can antibiotics cause a false negative urine culture leading to sterile pyuria?\",\r\n      \"acceptedAnswer\": {\r\n        \"@type\": \"Answer\",\r\n        \"text\": \"Yes. If a patient has a bacterial urinary infection but has taken antibiotics within the past 2 weeks, the antibiotic effect can suppress bacterial growth in the culture, resulting in a negative culture despite ongoing inflammation. This is one of the most common infectious causes of sterile pyuria.\"\r\n      }\r\n    },\r\n    {\r\n      \"@type\": \"Question\",\r\n      \"name\": \"Can pregnancy cause sterile pyuria?\",\r\n      \"acceptedAnswer\": {\r\n        \"@type\": \"Answer\",\r\n        \"text\": \"Yes. Normal pregnancy is one of the recognized causes of sterile pyuria. Pregnant women may show white blood cells in their urine without a bacterial infection due to physiological changes during pregnancy.\"\r\n      }\r\n    },\r\n    {\r\n      \"@type\": \"Question\",\r\n      \"name\": \"How is sterile pyuria treated?\",\r\n      \"acceptedAnswer\": {\r\n        \"@type\": \"Answer\",\r\n        \"text\": \"Treatment depends on identifying the underlying cause through careful history taking and appropriate investigations. If the cause is not harmful, the patient may simply be monitored with regular urine checkups rather than receiving unnecessary antibiotics. Understanding the root cause helps avoid inappropriate antibiotic use.\"\r\n      }\r\n    }\r\n  ]\r\n}\r\n<\/script>\n\n\n\n<h2 class=\"wp-block-heading\">What the two words mean<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><em>Pyuria<\/em> means white blood cells in the urine \u2014 the body&#8217;s inflammatory response. <em>Sterile<\/em> means a standard <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2012856\/\">urine culture<\/a> has grown no bacteria. Put together: something is inflaming the urinary tract, and it is not an ordinary bacterial infection.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The word <em>sterile<\/em> is misleading, because the commonest reason a culture grows nothing is that the organism responsible does not grow on a standard culture plate at all. The laboratory is not saying there is no infection. It is saying there is no infection <em>of the kind it was looking for<\/em>.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">A correction to the threshold given here previously<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">An earlier version of this article defined pyuria as more than two white cells per high-power field. <strong>That was a unit error and has been corrected.<\/strong> The figure of ten in the source literature refers to white cells <em>per microlitre<\/em> of uncentrifuged urine \u2014 roughly five or more per high-power field on a spun specimen. Set at two per field, almost everyone qualifies, and a normal result gets investigated as a disease.<\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><img data-recalc-dims=\"1\" decoding=\"async\" width=\"800\" height=\"533\" data-attachment-id=\"5232\" data-permalink=\"https:\/\/drsoaraweeurology.com\/my\/2022\/07\/07\/sterile-pyuria-general-ideas\/depression-stress-frustration-concept\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2022\/07\/Frustated.jpg?fit=1200%2C800&amp;ssl=1\" data-orig-size=\"1200,800\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;Depression, stress, frustration concept. Stressful woman has doctors appointment. Attentive psychotherapist listens to frustrated girls problem. Depression raises stress level. Simple flat vector&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;Depression, stress, frustration concept&quot;,&quot;orientation&quot;:&quot;1&quot;}\" data-image-title=\"Sterile pyuria always frustrated the patients as well as doctors while encountered this problem.\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;Sterile pyuria always frustrated the patients as well as doctors while encountered this problem.&lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2022\/07\/Frustated.jpg?fit=800%2C534&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2022\/07\/Frustated.jpg?resize=800%2C533&#038;ssl=1\" alt=\"Frustrated patient holding a laboratory report, illustrating repeated urine tests showing inflammation with no bacterial growth\" class=\"wp-image-5232\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2022\/07\/Frustated.jpg?w=1200&amp;ssl=1 1200w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2022\/07\/Frustated.jpg?resize=300%2C200&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2022\/07\/Frustated.jpg?resize=1024%2C683&amp;ssl=1 1024w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2022\/07\/Frustated.jpg?resize=768%2C512&amp;ssl=1 768w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2022\/07\/Frustated.jpg?resize=18%2C12&amp;ssl=1 18w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2022\/07\/Frustated.jpg?resize=750%2C500&amp;ssl=1 750w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption class=\"wp-element-caption\">Repeated courses of antibiotics for a culture that keeps coming back negative is the pattern that brings most people to the clinic.<\/figcaption><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">The two causes most often missed<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">1. A sexually transmitted infection<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">This is the first thing to exclude in anyone sexually active, and it was missing from the earlier version of this article altogether. <strong>Chlamydia, gonorrhoea, <em>Mycoplasma genitalium<\/em> and trichomonas all cause urethral inflammation and white cells in the urine, and none of them grows on a routine urine culture.<\/strong> In a man with urethral discomfort or discharge and a negative culture, this is the explanation until proved otherwise \u2014 and it is a diagnosis with consequences for a partner as well.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The test is a <a href=\"https:\/\/drsoaraweeurology.com\/2020\/05\/28\/stis-std-pcr-urine-test\/\">multiplex PCR on a urine sample<\/a>, not another culture. See also <a href=\"https:\/\/drsoaraweeurology.com\/2021\/10\/15\/gonorrhea-infection-guideline\/\">gonorrhoea<\/a> and <a href=\"https:\/\/drsoaraweeurology.com\/2021\/10\/08\/syphilis-correct-way-deal-with\/\">syphilis<\/a>.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">2. Urinary tuberculosis<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Genitourinary tuberculosis is uncommon but not rare in this region, and persistent sterile pyuria is its classic presentation. <em>Mycobacterium tuberculosis<\/em> does not grow on a standard urine culture, so the result is reported as sterile no matter how much infection is present.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">It is worth actively considering where pyuria is persistent and unexplained, particularly alongside past TB or TB contact, night sweats, weight loss, or long-standing urinary symptoms without a clear cause. Finding it requires specifically asking the laboratory for it \u2014 early-morning urine samples on separate days for mycobacterial culture or PCR, not the routine culture. This matters because untreated urinary TB scars the ureters and kidneys permanently, and that damage is not recoverable once done.<\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><img data-recalc-dims=\"1\" decoding=\"async\" width=\"800\" height=\"400\" data-attachment-id=\"5229\" data-permalink=\"https:\/\/drsoaraweeurology.com\/my\/2022\/07\/07\/sterile-pyuria-general-ideas\/blue-and-white-capsules-pills-pouring-from-the-bottle-on-white-background\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2022\/07\/ATB.jpg?fit=1200%2C600&amp;ssl=1\" data-orig-size=\"1200,600\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;9&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;ILCE-7M3&quot;,&quot;caption&quot;:&quot;Blue and white capsules pills pouring from the bottle on white background&quot;,&quot;created_timestamp&quot;:&quot;1569485923&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;200&quot;,&quot;iso&quot;:&quot;100&quot;,&quot;shutter_speed&quot;:&quot;0.004&quot;,&quot;title&quot;:&quot;Blue and white capsules pills pouring from the bottle on white background&quot;,&quot;orientation&quot;:&quot;1&quot;}\" data-image-title=\"History of current or recently antibiotic therapy may express this phenomenon.\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;History of current or recently antibiotic therapy may express this phenomenon.&lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2022\/07\/ATB.jpg?fit=800%2C400&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2022\/07\/ATB.jpg?resize=800%2C400&#038;ssl=1\" alt=\"Antibiotic capsules, illustrating how recent antibiotic treatment suppresses bacterial growth and produces a falsely negative urine culture\" class=\"wp-image-5229\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2022\/07\/ATB.jpg?w=1200&amp;ssl=1 1200w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2022\/07\/ATB.jpg?resize=300%2C150&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2022\/07\/ATB.jpg?resize=1024%2C512&amp;ssl=1 1024w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2022\/07\/ATB.jpg?resize=768%2C384&amp;ssl=1 768w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2022\/07\/ATB.jpg?resize=18%2C9&amp;ssl=1 18w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2022\/07\/ATB.jpg?resize=750%2C375&amp;ssl=1 750w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption class=\"wp-element-caption\">Antibiotics taken in the days before the sample are the commonest benign reason a culture grows nothing.<\/figcaption><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">The rest of the list<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Reasons the culture was negative when an ordinary infection was present<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Antibiotics taken recently<\/strong> \u2014 even a course finished for something else suppresses growth. The commonest explanation of all, and entirely benign.<\/li>\n\n\n\n<li><strong>A partly treated infection<\/strong>, or a sample taken after treatment had started.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Inflammation from a structural problem<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Stones<\/strong> anywhere in the urinary tract, which irritate the lining without infecting it.<\/li>\n\n\n\n<li><strong>A ureteric stent or catheter<\/strong>, or recent instrumentation \u2014 a foreign body produces inflammation by its presence.<\/li>\n\n\n\n<li><strong>Bladder cancer, particularly carcinoma in situ.<\/strong> This is the diagnosis not to miss. Persistent unexplained pyuria \u2014 especially with blood in the urine, in a smoker, or over the age of fifty \u2014 is a reason for urine cytology and cystoscopy rather than more antibiotics. The earlier version of this article linked malignancy to weight loss, which is the wrong trigger: bladder cancer at this stage causes no weight loss at all.<\/li>\n\n\n\n<li><strong>Inflammation next to the urinary tract<\/strong> \u2014 appendicitis, diverticulitis or pelvic inflammatory disease can all irritate the bladder wall from outside and put white cells in the urine.<\/li>\n\n\n\n<li><strong>Previous pelvic radiotherapy<\/strong> or prior urological surgery.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Medicines and medical conditions<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Drug-induced inflammation of the kidney<\/strong> \u2014 anti-inflammatory painkillers, proton pump inhibitors and some antibiotics including the penicillins can cause interstitial nephritis. A rash, fever or a rising creatinine alongside the pyuria points this way. <em>An earlier version of this article listed steroids among the causes; that has been removed, as it is not supported.<\/em><\/li>\n\n\n\n<li><strong>Bladder pain syndrome \/ interstitial cystitis<\/strong> \u2014 pain and urinary frequency with cultures that are always negative.<\/li>\n\n\n\n<li><strong>Kidney disease<\/strong>, including glomerulonephritis, where blood and protein usually appear alongside the white cells.<\/li>\n\n\n\n<li><strong>Systemic conditions<\/strong> such as lupus, and <strong>normal pregnancy<\/strong>, in which mild pyuria is common and means nothing.<\/li>\n\n\n\n<li><strong>Contamination<\/strong> from genital secretions during collection \u2014 the simplest explanation of all, and worth excluding with a properly taken midstream sample before anything else is done.<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" width=\"800\" height=\"533\" data-attachment-id=\"5233\" data-permalink=\"https:\/\/drsoaraweeurology.com\/my\/2022\/07\/07\/sterile-pyuria-general-ideas\/beautiful-pregnant-belly\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2022\/07\/Pregnancy.jpg?fit=1200%2C800&amp;ssl=1\" data-orig-size=\"1200,800\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;9&quot;,&quot;credit&quot;:&quot;Sergejs Rahunoks&quot;,&quot;camera&quot;:&quot;Canon EOS 5D Mark II&quot;,&quot;caption&quot;:&quot;Beautiful pregnant belly on a white background&quot;,&quot;created_timestamp&quot;:&quot;1365178529&quot;,&quot;copyright&quot;:&quot;Sergejs Rahunoks @ YekoPhotoStudio&quot;,&quot;focal_length&quot;:&quot;100&quot;,&quot;iso&quot;:&quot;125&quot;,&quot;shutter_speed&quot;:&quot;0.008&quot;,&quot;title&quot;:&quot;Beautiful pregnant belly&quot;,&quot;orientation&quot;:&quot;1&quot;}\" data-image-title=\"Even a normal pregnancy could possibly shows Sterile pyuria.\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;Even a normal pregnancy could possibly shows Sterile pyuria.&lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2022\/07\/Pregnancy.jpg?fit=800%2C534&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2022\/07\/Pregnancy.jpg?resize=800%2C533&#038;ssl=1\" alt=\"Pregnant woman, illustrating that mild pyuria on a urine test is common in normal pregnancy and usually not significant\" class=\"wp-image-5233\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2022\/07\/Pregnancy.jpg?w=1200&amp;ssl=1 1200w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2022\/07\/Pregnancy.jpg?resize=300%2C200&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2022\/07\/Pregnancy.jpg?resize=1024%2C683&amp;ssl=1 1024w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2022\/07\/Pregnancy.jpg?resize=768%2C512&amp;ssl=1 768w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2022\/07\/Pregnancy.jpg?resize=18%2C12&amp;ssl=1 18w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2022\/07\/Pregnancy.jpg?resize=750%2C500&amp;ssl=1 750w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption class=\"wp-element-caption\">Mild pyuria is common in an entirely normal pregnancy.<\/figcaption><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">What sensible management looks like<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The earlier version of this article ended by advising observation with regular urine testing where the cause seemed harmless. That has been replaced, because repeatedly testing urine without a plan produces repeatedly abnormal results and repeated antibiotics \u2014 the same trap described in <a href=\"https:\/\/drsoaraweeurology.com\/2022\/07\/22\/asymptomatic-bacteriuria\/\">bacteria in the urine with no symptoms<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A more useful sequence is: confirm the sample was properly taken; establish whether antibiotics had been taken beforehand; test for sexually transmitted infection where there is any possibility of it; and if the pyuria persists without explanation, investigate deliberately for tuberculosis, for stones, and for bladder cancer \u2014 rather than prescribing again and waiting.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A single episode of mild pyuria in someone well, particularly after recent antibiotics or in pregnancy, generally needs nothing at all.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Symptoms that need attention rather than a routine appointment<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">In an emergency in Thailand, call <strong>1669<\/strong>.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Fever with flank or back pain, or shaking chills.<\/li>\n\n\n\n<li>Visible blood in the urine, with or without clots.<\/li>\n\n\n\n<li>Inability to pass urine.<\/li>\n\n\n\n<li>Unexplained weight loss, drenching night sweats, or a persistent cough alongside the urinary findings.<\/li>\n\n\n\n<li>A new rash or a falling urine output after starting a new medicine.<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Frequently Asked Questions<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Q1: What is sterile pyuria?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">White blood cells in the urine with a standard urine culture that grows no bacteria. It indicates inflammation of the urinary tract from something other than an ordinary bacterial infection \u2014 often an organism that a routine culture cannot grow.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Q2: Does it mean the antibiotic failed?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Usually the reverse. If antibiotics were taken in the days before the sample, they are the likeliest reason nothing grew. Repeating the course is the wrong response; establishing what is causing the inflammation is the right one.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Q3: Could it be a sexually transmitted infection?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Yes, and this is the first thing to exclude in anyone sexually active. Chlamydia, gonorrhoea, <em>Mycoplasma genitalium<\/em> and trichomonas all cause pyuria and none appears on a routine urine culture. A multiplex PCR on urine is the test; it also matters for partners.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Q4: Can tuberculosis cause sterile pyuria?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Yes. Urinary tuberculosis is the classic cause of persistent unexplained sterile pyuria and does not grow on a standard culture. Diagnosis requires specifically requesting mycobacterial testing on early-morning urine samples taken on separate days. Early diagnosis matters because untreated urinary TB causes permanent scarring of the ureters and kidneys.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Q5: Could it be cancer?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">It can be. Carcinoma in situ of the bladder produces inflammation and irritative urinary symptoms with negative cultures, and it causes no weight loss at that stage. Persistent unexplained pyuria \u2014 particularly with blood in the urine, in a smoker, or over fifty \u2014 warrants urine cytology and cystoscopy rather than further antibiotics.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Q6: When should I see a urologist?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">When the pyuria is persistent or recurrent, when it comes with blood in the urine, flank pain, weight loss or night sweats, or when no benign explanation such as recent antibiotics, contamination or pregnancy fits. Bring the actual laboratory reports and a list of every antibiotic taken in the preceding weeks \u2014 those two things shorten the process considerably.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Arranging a consultation<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Dr. Soarawee Weerasopone sees patients at <a href=\"https:\/\/www.bangkokhospital.com\/en\/bangkok\/doctor\/dr-soarawee-weerasopone-2\">Bangkok Hospital Headquarters<\/a> and at Samitivej Sriracha Hospital in Chonburi on <a href=\"tel:0880221445\">088-022-1445<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Bangkok Hospital Telemedicine is available for patients who cannot attend in person, including international patients \u2014 arrange it in advance by email to the Urology department at <a href=\"mailto:bhquro@bdms.co.th\">bhquro@bdms.co.th<\/a>. Samitivej Sriracha is in-person only. Enquiries about cost are answered by the hospital, not by this website.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Disclaimer:<\/strong> This content is written and reviewed by Dr. Soarawee Weerasopone, a board-certified urologist at Bangkok Hospital Headquarters, and is intended for education only. It is not medical advice, diagnosis or a prescription for any individual, and no advice, diagnosis or prescription is given through personal messaging channels or social media. Dr. Soarawee operates no public social media account; any account offering private consultation in his name is fraudulent. In an emergency in Thailand, call <strong>1669<\/strong>.<\/p>\n\n\n\n<script type=\"application\/ld+json\">\n{\n  \"@context\": \"https:\/\/schema.org\",\n  \"@graph\": [\n    {\n      \"@type\": \"MedicalWebPage\",\n      \"@id\": \"https:\/\/drsoaraweeurology.com\/2022\/07\/07\/sterile-pyuria-general-ideas\/#webpage\",\n      \"url\": \"https:\/\/drsoaraweeurology.com\/2022\/07\/07\/sterile-pyuria-general-ideas\/\",\n      \"name\": \"White Cells in the Urine With a Negative Culture: What Sterile Pyuria Actually Means\",\n      \"description\": \"Pyuria with a negative urine culture usually means the responsible organism does not grow on standard culture. 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Mycobacterial testing on early-morning urine samples must be requested specifically. Untreated, it scars the ureters and kidneys permanently.\" }\n        },\n        {\n          \"@type\": \"Question\",\n          \"name\": \"Could sterile pyuria be cancer?\",\n          \"acceptedAnswer\": { \"@type\": \"Answer\", \"text\": \"It can be. Carcinoma in situ of the bladder produces inflammation and irritative symptoms with negative cultures and causes no weight loss at that stage. Persistent unexplained pyuria, particularly with blood in the urine, in smokers or over fifty, warrants urine cytology and cystoscopy.\" }\n        }\n      ]\n    }\n  ]\n}\n<\/script>\n","protected":false},"excerpt":{"rendered":"<p>A urine test showing inflammation but growing no bacteria is not a failed antibiotic \u2014 it is a signal to look elsewhere. The two causes most often missed are a sexually transmitted infection and urinary tuberculosis.<\/p>","protected":false},"author":185281453,"featured_media":10096,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"advanced_seo_description":"White cells in the urine with no bacterial growth. 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