Pyuria and bacteriuria


  • Described as urine containing pus cells 
  • The name pyuria itself describes  the meaning “Py” -pus cells “Uria” – urine 
  • It is a relative symptom which is related to white blood cells
  • The normal amount of  pus cells in urine is about 0-5 /hpf 
  • It is identified as pyuria if the person has UTI and 10 wbc’s per cubic millimeter of blood
  • It is often associated with infections or no infection




  • The primary possible cause is from the bacterial urinary tract infections which affects the bladder,urethra,if untreated can affect  kidneys as well
  • Pyelonephritis is a condition where the inflammation of the kidney parenchyma ,pelvis .

Other causes would be 

  • Bladder infection
  • Benign prostatic hyperplasia (BPH) 
  • Prostatitis 
  • Sexually transmitted diseases (HIV,gonnorehea,HPV etc )
  • Viral,fungal, parasitic infections 
  • Painful bladder syndrome
  • Pelvic Infections
  • Sepsis
  • Urinary fistulas 
  • Radiation cystitis
  • Transvaginal mesh
  • Renal transplantation rejections
  • Tuberculosis
  • Renal stones/urolithiasis 
  • Intrinsic kidney disease
  • Polycystic kidney disease
  • Autoimmune diseases
  • Certain long term usage of medications such as penicillin+antibiotics,Aspirin, Diuretics,NSAIDS ,proton pump inhibitors etc




Symptoms include 

  • Frequent urination
  • Blood in urine 
  • Cloudy/Bloody urination
  • Difficulty during urination(burning sensation)
  • Bad odor during urination


If there is no possible UTI then the symptoms are 


  • Nausea,vomiting
  • Discharge 
  • Abdominal pain
  • Fever & chills 
  • Bladder pain


Risk factors 


  • More prone in older age group
  • The higher rate of relevance in females than male (because of shorter urethra in women )
  • Menopausal women 
  • Pregnant women 
  • STD’s
  • If BPH is untreated there is a possible risk of kidney failure / Renal stones



  • Urine analysis to look at the presence of blood cells,pus cells,bacteria etc 
  • If the presence of leukocytes or nitrites in the urine then the possible diagnosis include an urinary tract infection 
  • If not present , the need to evaluate the cause is the prerequisite.




  • Permanent Kidney disease
  • Severe condition leads to death




  • If in case of UTI -Antibiotics is prescribed orally for 2 weeks 

Sometimes it is important to rule out the cause and advise accordingly, if not antibiotics may severe the condition. 

  • Fungal origin of infections treated with  antifungal therapy
  • If not responded to antibiotics then rule out the autoimmune  history and advise immunoglobulins and inhibit prescription of other drugs 


1.What does pyuria indicate?


  • Often indicates infection in the urinary tract .Sometimes may be due to urethral devices. 


2.How do you prevent pyuria?


  • Firstly take precautions to not get attacked by any urinary tract infections by following simple steps such as drinking enough water ,maintaining the area,and urinating often.


3.How do you treat pyuria at home?


  • Consuming plenty of fluids 
  • Vitamin C rich foods
  • Addition of probiotics to diet 
  • Practice hygienic lifestyle 


4 .How do you investigate pyuria?


  •  Urinalysis is prime way to investigate ,Urine cultures provide proof of the bacterial colonies and type of bacteria present,microscopic evaluation to study the no of  leukocytes in urine and LE values 


5..What does pyuria look like?


  • Pyuria looks like an urinary condition,basically a symptom with elevated number of white blood cells in urine.Its appearance is cloudy white 


6.Can pyuria cause back pain?


  • Yes,it does cause severe backache due to infection or any obstruction 


7.What is the best antibiotic for UTI?


  • Trimethoprim/sulfamethoxazole 
  • Fosfomycin 
  • Nitrofurantoin 
  • Cephalexin 
  • Ceftriaxone
  • Analgesics


8.Which bacteria causes pus in urine?


  • Escherichia coli  commonly referred as E.coli  found in colon is the prime suspect of pyuria .However ,there are few other microorganisms such as enterococcus,klebsiella,candida sps 


9.What is asymptomatic pyuria?


  • Presence of 5-9 WBC’s /hpf with no relevant symptoms related to UTI.


10.Can you have UTI without pyuria?


  • Yes, there are not often many situations where pyuria is definitely associated with UTI .About 15% of cases usually doesnot present with pyuria because there is no evidence of E.coli.


11.What is bacteriuria with pyuria?


  • Wbc’s are not usually seen commonly in bacterial urinary tract infections ,but some shows pus cells with bacteria in urine .Infections includes tuberculosis ,chlamydia , gonorrhea,mycoplasma
  • Bacteriuria without pyuria may occur in cases of asymptomatic patient with diabetes, enteric fever or bacterial endocarditis or during pregnancy


12.Can there be UTI without pus cells in urine?


  • Yes,there can be  infection with no pus cells when the infection is mild to moderate without any renal involvement /medications 


13.Why am I having UTI symptoms but no infection?


  • The presence of infection is only known with proper evaluation and investigations .The symptoms may not be caused by bladder infection but may be due to infection/inflammation in the urethra.


14.How to treat back pain in pyuria cases ?


  • Mild spasmodics or muscle relaxant can relieve pain with certain antibiotics 




  • It is defined as bacteria in urine 
  • “Bacteri ”  indicates bacteria ” uria ” indicates urine 
  • It is classified as symptomatic or asymptomatic bacteriuria
  • If there is no presence of symptoms but have the colonization of 1 / more  bacteria  then it is described as asymptomatic 
  • If patient presents with no symptoms does not considered as an infection 




Some of the possible complicated causes 


  • such as pyelonephritis 
  • Cystitis 
  • Urinary Bacterial Infections 
  • Obstructive disorders or congenital abnormalities
  • Immunocompromised patients 

Urethral catheters or any related devices 


Uncomplicated conditions such as Urinary tract infection in healthy individual with no underlying conditions as mentioned above 




  • Frequent urination 
  • Difficulty during passing urine
  • Fever
  • Back pain
  • Abdominal pain
  • Blood in the urine 


Risk factors 


  • Females are more affected than men
  • Age above 65 years old
  • Post menopausal women 
  • Pregnant women 
  • Patients with chronic indwells ,urethral catheters or any related devices 




  • The primary test is through urinalysis and urine,blood cultures 
  • On examination if  the urine contains white blood cells , leukocyte esterase or increased nitrate levels then there is a possibility of infection
  • Elevated values should be taken into  consideration in cases of chronic indwells ,catheters who are at higher risk and ensure to check at the clinical symptoms and treated beforehand with antibiotics.
  • If the culture show positive results with 1000 CFU / min  can have UTI
  • Imaging studies should be advised such as CT scanning only if there is no history renal stones 




  • Antibiotics -fluoroquinolones ,sulfamethoxazole,trimethoprim,beta-lactams, nitrofurantoin
  • Treated by 3-7 in case of cystitis,5-15 days in pyelonephritis.
  • In cases of suspected bacteria in blood then bactericidal antibiotics are prescribed 


1.What is the most common cause of bacteriuria?


  • The most common cause of bacteriuria is by infections by E.coli 


2.What is bacteriuria and when is it significant?


  • Presence of bacteria in urine .it is significant when urine sample contains more than 10⁵colonies/ml in culture study 


3.Is bacteriuria same as UTI


  • No,UTI is the condition where the patient present with infection with the possible symptoms whereas in Bacteriuria there is no evidence of symptoms but with  bacteria 


4.What causes bacteriuria


  • The common cause of bacteriuria is by Bacteria called E.coli 


5.What is the difference between bacteriuria and pyuria?


  • Bacteria in urine is bacteriuria
  • Pus cells or WBC ‘ in urine is pyuria 
  • The main cause of pyuria is UTI but in contrast infection by E.coli is the primary cause 

6.How do you treat bacteriuria


  • Symptomatic bacteriuria is treated with drinking plenty of water,antibiotics, antimicrobial therapy and practicing hygiene routine  


7.What disease bacteriuria is typical for 


  • Typical for no disease but situations such as chronic usage of catheters,those with surgically treated urinary tracts or renal transplantation , pregnant women,sometimes in Urinary tract infected women or men .


8.Is bacteria in urine serious?


  • Of Course yes, consult urologist to find out the possible cause and get treatment done to prevent from future complications 


9.Is bacteriuria is an infection 


  • Not an infection but present with an infection in urinary tract 


10.What causes bacteria in urine female


  • It is similar to both genders caused by the same organism known as E.coli but the disease relevance is more in women than men due to shorter urethra .


11.What are stages of UTI


  • There are no specific stages to mention but UTI proceeds further with possible symptoms which over time it  becomes severe and makes the condition worse.Symptoms include frequent urination, irritation ,pressure over bladder,cloudy urine 

12.What should you not to do when you have UTI


  • Avoid carbonated drinks and beverages
  • Consult urologist immediately
  • Not consuming enough water
  • Avoid delaying emptying the bladder 
  • Eat healthy diet 


13.What is the difference between UTI and

 bladder infection


  • A UTI is defined as an infection in one or more places in the urinary tract—the ureters, kidneys, urethra, and/or bladder
  • A bladder infection is a UTI that’s only affected in a specific part that is i;e the bladder.


14.What causes asymptomatic bacteriuria


  • The cause is similar to that of symptomatic bacteriuria by E coli  colonization in urine 


15.Should I treat asymptomatic bacteriuria


  • Probably there is no need of medications for asymptomatic bacteriuria until the symptoms are evident .Taking appropriate precautions can eliminate the infection


16.Is asymptomatic bacteriuria a UTI


  • No, asymptomatic bacteriuria is not an UTI 


17.When do you treat asymptomatic bacteriuria 


  • If there is predictable risk of infection to the patient then the treatment includes Antibiotics priorly or else there is no requirement of treatment or else it will worsen the condition of patient 


  1. What is significant bacteriuria 


  • Symptomatic bacteriuria is known as significant bacteriuria with possible symptoms


19..Can there be bacteria in urine without infection?


  • Most of the time the urine is sterile with no microorganisms. Diseases in kidney or urinary tract infections possibly present with the appearance of infection.


Back to Top