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Pus Cells in Urine: Understanding Importance and Normal Ranges

The presence of pus cells in urine, known as pyuria, often accompanies bacteriuria (presence of bacteria in urine), which can either be asymptomatic or can be associated with cloudy (turbid) urine and pain in bladder (cystitis). Presence of pus cells in urine samples >5/High power field can be suggestive of an underlying urinary tract infection (UTI). 

UTIs are among the most common bacterial infections that lead patients to seek medical care. Success of diagnostic and treatment plan is based on determining the location of the UTI. Urinary tract infections are characterized as being either upper (U-UTI) or lower (L-UTI) based primarily on the anatomic location of the infection: the lower urinary tract includes the bladder and urethra, and the upper urinary tract encompasses the ureters and kidneys. UTIs can be complicated or uncomplicated. Females are more prone to develop UTIs due to short urethra and proximity to the anal region. 20% of females experience at least one UTI in her lifetime.  It is the most prevalent bacterial infection and the second most common type of infection in humans. About 8.1 million people seek medical attention for urinary tract infections annually.

Pus cells in urine can be a useful diagnostic tool for urine pathologies that helps clinicians to start early treatment and prevent them from the complications. Let’s know more about this in the following article.

What are Pus Cells?

White blood cells or leukocytes are known as pus cells build up when the body's immune system becomes active in reaction to an infection. Urinary leukocytes are present in infectious processes such as cystitis, glomerulonephritis, and catheter-associated urinary tract infection, and the report of their presence (pyuria) is helpful in the determination of disease. Pyuria is the term in which white blood cells are found in the urine. Pyuria may manifest as non-sterile or sterile. Non-sterile pyuria results from the presence of pus cells with bacteria, whereas sterile pyuria is defined as the presence of pus cells in the urine without any bacteria being detected (Commonly seen in  tuberculosis cases).

What is the Purpose of Testing Pus Cells in Urine? 

Pus cells in urine testing is generally recommended to the patients who are presented with  symptoms like dysuria (painful micturition), increased frequency of urine,  pain in bladder, urinary incontinence, increased urge to pee, and fever.  Turbid (cloudy) urine can be seen in UTI patients, Detection of pus cells in urine along with other findings and urine culture report help in timely treatment of symptomatic patients with antibiotics. Pyuria is a sensitive (80-95%) but nonspecific (50-76%) sign of UTI. Microscopic analysis that shows pyuria and/or positive nitrite and leukocyte esterase tests can be helpful as presumptive evidence of UTI.

What is the Significance of Pus Cells in Urine?

Pyuria is most frequently seen in UTIs. there are certain other conditions where pus cells can be seen in urine:

  • STIs/STDs (such as gonorrhea, chlamydia,  human papillomavirus infection, syphilis, human immunodeficiency virus infection)
  • Pneumonia
  • Interstitial cystitis/painful bladder syndrome
  • Sepsis (widespread bacterial infection in the body)
  • Tuberculosis
  • Organ transplant rejection
  • Kidney stones
  • Vaginitis
  • In catheterized patients

Pyuria can also result from taking specific kinds of medications, particularly if taken over an extended length of time. Among these drugs are:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, and naproxen sodium
  • Penicillin or sulfa antibiotics
  • Diuretics (water pills)
  • Antacids

What is the Normal Range of Pus Cells in Urine?

A small number of pus cells in the urine sample of a healthy person is normal (<5/HPF). This normal range of pus cells in urine can vary slightly depending on factors such as age and sex.

What are the Symptoms of UTI with Presence of Pus Cells in Urine?

The most typical sign of pyuria is turbid (cloudy or pus-filled) urine. When a UTI causes pyuria, you might experience the following symptoms:

  • Pain or discomfort in your pelvis, abdomen, or side (flank)
  • Sensation of bladder fullness or lower abdominal discomfort
  • Increased frequency of urination
  • Sudden, intense urges to urinate frequently
  • Leaking pee, or incontinence
  • Dysuria, or pain during urination
  • Urine with blood in it (hematuria)
  • Fever, chills and malaise (commonly with cystitis and upper UTI frequently)
  • Nausea & vomiting

How are Pus Cells in Urine Tested?

A urine sample is required in order to perform a simple urine test called urinalysis to check pus cells in urine. Your doctor will advise you to collect the urine sample. Preferred urine sample is early morning clean catch midstream sample. Before collection, a sterile wipe is used to clean the urethral opening in order to minimize the presence of contaminants. Midstream urine specimens may become contaminated, particularly if the woman finds difficulty in spreading and maintaining separation of the labia. 

The accuracy of test results may be affected by the quality of the sample submitted, so make sure you carefully follow the instructions of your doctor regarding the collection of urine samples. You might have to fast beforehand if the urinalysis is being done in conjunction with other tests, though. Your physician will provide guidance.

Certain medications, including over-the-counter medicines and dietary or herbal supplements, can influence the results of a urinalysis. Before the test, let your doctor know about all the vitamins, supplements, and medications (especially antibiotics without prescription) you take.

What is the Treatment for Pus Cells in Urine?

The course of treatment for pyuria is determined by your doctor's final diagnosis after reviewing your urine test results. When treating UTIs, doctors frequently recommend the following antibiotics:

  • Nitrofurantoin
  • Sulfonamides or sulfa drugs like  sulfamethoxazole/trimethoprim.
  • Cephalosporins
  • Fosfomycin
  • Doxycycline
  • Amoxicillin
  • Quinolones like ciprofloxacin or levofloxacin

Point to remember: These antibiotics should not be taken without the advice of a medical professional. Irrational use of antibiotics may lead to development of resistant bacteria that further complicate your infection.

Natural way to reduce pus cells: Stay hydrated, maintain proper hygiene of genital area, avoid irritants like alcohol, spicy food etc. and can use cranberry products (studies show that they prevent adherence of bacteria to urinary tract linings)


If you have pyuria, it means that your urine has pus or white blood cells. Noticing that your urine has a bad odor or is cloudy can be disturbing. Consult the medical expert if you notice any such changes in your urine and symptoms of UTI. They are able to send urine tests to identify pyuria with other relevant tests and diagnose its cause. 

If you notice any urinary symptoms mentioned, seek medical attention right away. 

Frequently Ask Questions

Q1: Is the presence of pus cells in urine serious?

A: Urine with pus cells indicates a urinary tract infection, and in more severe cases, it can also indicate sepsis or another medical condition. In light of this, you must arrange a urine test right away if you experience any of the urinary symptoms.

Q2: Which medication works best for the urinary infection with pyuria?

A: The underlying cause of pyuria determines the course of treatment. Pyuria is typically the result of a UTI, which is treated with a brief course of antibiotic therapy

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