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Recurrent Pyuria, Negative Culture
60-year-old female with recurrent abnormal urine routine tests (2–3 episodes) despite urine cultures not showing bacterial growth.
Current urine routine:
* Pus cells >120 WBC/HPF (normal 0–5)
* Leukocyte esterase 3+
* RBC 10–13/HPF
* Blood 2+
* Nitrite negative
* No crystals/casts
* No burning or other significant urinary symptoms
Previous urine test also showed 25–30 pus cells/WBC per HPF.
Current urine culture interim report shows no organism isolated so far, and similar culture-negative episodes have happened previously.
What could cause recurrent high pus cells/pyuria with negative urine cultures, and which specialist should we consult? Should this be investigated further before giving repeated antibiotics?
Answers (11)
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Pus cells this high with a negative culture usually mean something other than a typical bacterial infection, especially since you don't have burning or other symptoms.
Next Steps
A urologist or urogynaecologist can guide you through further tests like urine cytology or imaging before any more antibiotics.
Health Tips
Repeated antibiotics without a confirmed infection can do more harm than good, so it's worth getting this properly evaluated first.
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