From the Research
For symptomatic sterile pyuria in a 23-year-old female with one pregnancy and one delivery, I recommend empiric treatment with nitrofurantoin 100mg twice daily for 5 days or trimethoprim-sulfamethoxazole (TMP-SMX) 160/800mg twice daily for 3 days, as the most recent and highest quality study 1 suggests a high prevalence of asymptomatic bacteriuria and sterile pyuria among pregnant women.
Causes of Sterile Pyuria
The causes of sterile pyuria are multifactorial and can include:
- Partially treated UTIs
- Kidney stones
- Interstitial cystitis
- Sexually transmitted infections like chlamydia or gonorrhea
- Tuberculosis of the urinary tract
Diagnostic Approach
Before starting treatment, obtain a urine culture to confirm the absence of bacterial growth, as sterile pyuria refers to the presence of white blood cells in the urine without bacterial growth on standard culture 2. Additional testing should include screening for STIs with nucleic acid amplification tests for chlamydia and gonorrhea.
Management
If symptoms persist after treatment or recur frequently, consider referral to urology or gynecology for further evaluation, including possible cystoscopy or imaging studies. Encourage increased fluid intake, complete emptying of the bladder, and urination after sexual intercourse to help prevent recurrence. The patient should follow up if symptoms worsen or do not improve within 48-72 hours of starting treatment, as this may indicate a need for alternative antibiotics or further diagnostic workup.
Considerations
It is essential to note that the presence of sterile pyuria may be an indication of asymptomatic renal impairment, which is often overlooked in antenatal management 1. Therefore, a thorough evaluation and management plan should be implemented to prevent potential complications.