Imagine going for a urine (pee) test at the doctor’s office and being told that there seems to be white blood cells and pus in your urine sample. Nothing feels off, you don’t feel any different, and there doesn’t seem to be any changes or pain when you pee. But then, each time you visit the doctor’s office, it seems to creep up over and over. This repeated presence of white blood cells in urine is known as Chronic pyuria, and while it might seem harmless at first glance, it’s often your body’s way of sounding the alarm.

What is Pyuria?

Pyuria is a condition characterised by the presence of pus or white blood cells in the urine. Usually, this is a sign that the urinary tract is fighting an infection,or dealing with inflammation as a result of other health conditions. When pus is found in your urine repeatedly over a long period, it is known as chronic pyuria, If left untreated, chronic pyuria can lead to more serious health complications, including kidney damage, UTI (urinary tract infection), and even long-term complications of the bladder.

What causes chronic Pyuria?

Chronic pyuria isn’t a diagnosis itself but rather a symptom of something else happening in the body. The most common causes include:

Urinary Tract Infections (UTIs)

The most common cause of chronic pyuria is a lingering or untreated UTI. Bacteria can enter the urinary tract, causing inflammation, which tells the immune system to send white blood cells to fight the infection. Even if the infection clears up, recurring UTIs can lead to chronic pyuria as a result of the amount of white blood cells circulating in the system.

Interstitial cystitis (Bladder pain syndrome)

Interstitial cystitis is a chronic condition which causes long-term inflammation of the bladder, with symptoms that are often similar to a UTI but without any signs of infections or bacteria.² It’s more common in women and can lead to the development of chronic pyuria.

Kidney infections (Pyelonephritis)

Kidney infections occur when bacteria travel up the urinary tract and infect the kidneys, leading to an even more severe infection than in UTIs.³ Chronic pyuria can linger after a kidney infection, especially if the infection isn’t fully treated or recurs.

Urinary catheters or foreign bodies

Catheters (a flexible tube which is used to empty the bladder) or other medical devices can irritate the lining of the urinary tract and introduce bacteria, leading to infection and the release of white blood cells in the urine.⁴

Sexually Transmitted Infections (STIs)

Some STIs, such as chlamydia or gonorrhea, can cause inflammation in the urinary tract and contribute to the development of chronic pyuria, especially if left untreated.¹

Bladder or kidney stones

Bladder or kidney stones are small, hard deposits which are passed through the urine, which can cause irritation and infection as they move through the urinary tract, triggering chronic inflammation and pyuria.

Autoimmune conditions

In some rare cases, autoimmune disorders such as lupus nephritis can cause inflammation in the kidneys and urinary tract, leading to persistent pyuria.

Who is at risk?

Chronic pyuria typically occurs in the following people:

• Individuals who are pregnant are more likely to develop chronic pyuria due to hormonal changes and increased pressure on the bladder, making them more susceptible to UTIs
• Older individuals, particularly those in care facilities such as care homes or hospices, or who have urinary catheters, are also more likely to develop the condition
• People with weakened or compromised immune systems, which can be due to chronic illness or medications, may be less able to fight off infections, leading to the development of chronic pyuria

What are the key signs of chronic pyuria

Since chronic pyuria itself doesn’t always cause noticeable symptoms, it can easily go untreated. However, since other underlying conditions sometimes cause the condition, other symptoms and signs can appear, including:

• The feeling of needing to pee or pain when you pee
• Cloudy or unpleasant-smelling urine
• Pain in the groin area/lower back
• Blood in the urine

In more severe cases of chronic pyuria, an individual could experience persistent fevers or chills. In these cases, individuals should seek immediate medical attention.

What are the long-term effects of chronic pyuria?

If left untreated, chronic pyuria can lead to a range of serious long-term health complications, including:

Kidney damage

Persistent inflammation of the urinary tract can lead to damage to the kidneys, which can reduce kidney function and even lead to scarring of kidney tissue.

Persistent UTIs

If the underlying cause of pyuria, such as UTIs, is left untreated, the frequent bacterial infection of the urinary tract can lead to a repeating cycle of infection and inflammation.

Bladder pain and reduced bladder capacity

For individuals with chronic pyuria caused by conditions like interstitial cystitis, they may experience pain and the feeling of needing to pee more often.

Some studies have shown that pregnant women with untreated chronic pyuria may experience a higher risk of premature birth and low birth weight. In severe cases, untreated infections can lead to sepsis, a life-threatening condition where the infection spreads throughout the body.

How is chronic pyuria diagnosed?

As chronic pyuria can sometimes be caused by underlying conditions, doctors may need to find the root cause. Tests might include:

• Urine cultures are usually the first test conducted by doctors to try and identify bacteria or fungi which could be causing the UTI
• Doctors might also try using an ultrasound or CT scan to check for the presence of kidney stones, tumours, or any changes in the structure of the kidneys
• A cystoscopy might also be performed, where a thin tube with a camera is inserted into the bladder to take a look at the urinary tract
• Blood tests might also be performed to assess kidney function and to check for the presence of any autoimmune conditions

How can we treat chronic pyuria?

Treating chronic pyuria usually involves finding and treating the root cause of the condition, and treatment options can vary depending on the cause:

Antibiotics

If a bacterial infection is the culprit, a course of antibiotics is the first line of defence. If the individual has repeated bacterial infections, low-dose antibiotics may be prescribed over a longer period of time.

Anti-inflammatory medications

For conditions like interstitial cystitis, anti-inflammatory drugs can help manage inflammation and reduce discomfort.

Catheter maintenance

For individuals who have urinary catheters, maintaining good hygiene practices can prevent infections that contribute to pyuria.

STI treatment

If the cause of chronic pyuria is determined to be a UTI, antiviral medication or antibiotics may be prescribed.

Management of chronic conditions

For individuals with autoimmune conditions or chronic diseases such as lupus or diabetes, a long-term treatment plan created by a doctor can help manage inflammation and prevent further complications.

How can we prevent chronic pyuria?

Whilst most cases of chronic pyuria originate from pre-existing conditions which require specialised treatment, there are some ways to help alleviate or prevent chronic pyuria. Some examples of preventative measures include:

• Drinking plenty of water can help flush any bacteria from the urinary tract
• After using the toilet, wipe front to back and avoid using harsh soaps, detergents or douches that could irritate the urinary tract
• Empty the bladder, particularly after sexual activity, to prevent any bacteria from travelling into the urinary tract
• Treat UTIs and other infections early to prevent them from becoming chronic

Summary

Chronic pyuria is a condition where white blood cells or pus are found in the urine, often due to an underlying issue or condition such as UTIs, interstitial cystitis, kidney infections, or autoimmune conditions. While it may not cause noticeable symptoms, untreated chronic pyuria could lead to severe health complications like kidney damage, persistent infections, and bladder pain. 

Diagnosis of chronic pyuria usually involves urine tests, imaging, and sometimes cystoscopy in more severe cases. Treatment options depend on the cause and may include medications such as antibiotics, anti-inflammatory drugs, or managing chronic conditions. Preventative measures like staying hydrated and maintaining good hygiene practices can help reduce the risk of getting chronic pyuria.