Bacteruria and no pyuria.

  Hi  Female late 20s.     Have had numerous UTIs , the first few were mixed strep which were treated with a 10 day course of antibiotics each time --  and the last 6 or so infections have switched over to klebsiella A , +3  treated in the same manner.

  There has never been so much as one leucocyte in the urine in any of these infections . Why so?   4-8 epithelial cells.  There is  moderate microscopic hematuria. Following antibiotic treatment the hematuria always remains, however it is minimal.

My symptoms are flank and back pain, chills,  and a vertical pain on the far left side of the abdomen that shoots down when bending over  -- the pain is releived some through urination.  Antibiotics have absolutely no effect on symptoms at all . My urologist was initially treating this as routine cystitis with macrobid , and now is saying that he is not sure if these are even true infections.

So can healthy people have Bacteruria  and no pyuria? and if there was a problem, what do these types of infections usually indicate ?  The flank pain came on about 15 minutes after a weight lifting accident, felt a couple of major tearing sensations-- have had pressure problems, , and ongoing abdominal bruising problems.. Maybe these so called infections were just an incidental finding? . Is it absolutely necessary to treat them in your opinion ? I Developed severe nosebleeds while on cipro and my pt ptt and INR are all presently elevated , am awaiting follow up with a hematologist.  , am  becoming increasingly antibiotic weary.    Had a negative ultrasound, as well as a negative ct. Am awaiting an MRI.

Tried to have an IVP but due to a history of anaphylactic reactions  , it wasn't possible. What is the best equivilent test?  Thanks

  

[Kevin Pho, MD]

Abscence of pyuria suggests a non-infections cause of the UTI.  That being said, there are cases of asymptommatic bacteriuria in those who are pregnant and in diabetics.  

In most cases in healthy people, there are no indications to treat asymptommatic bacteriuria.  The exceptions would include pregnancy, before a urologic procedure, and in some patients with kidney stones.

Regarding the blood in the urine - if infection has been ruled out, I would consider a cystoscopy to evaluate for any possibility of bladder diseases such as cancer or polyps.  This can be discussed with your urologist.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
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