Can gonorrhea cause an elevation of white blood cells (WBC) in urine?

Can Gonorrhea Cause Elevation of WBC in Urine?

Yes, gonorrhea can cause elevation of white blood cells (WBC) in urine through urethral inflammation (urethritis), which is a hallmark manifestation of gonococcal infection.

Mechanism of WBC Elevation in Gonococcal Infection

Gonorrhea causes urethritis, which is characterized by urethral inflammation that directly leads to increased WBC in urine. 1

The diagnostic criteria for urethritis specifically include:

• Positive leukocyte esterase test on first-void urine, which detects WBC in urine 1
• Microscopic examination of first-void urine demonstrating ≥10 WBC per high-power field 1
• Microscopic evidence of urethritis showing ≥5 WBC per high-power field on Gram stain of urethral smear 1

Clinical Presentation

In men with gonococcal urethritis:

• Penile discharge (mucopurulent or purulent) is common 2
• Dysuria frequently accompanies the infection 2, 3
• The inflammatory response produces the elevated WBC count in urine 1

In women with gonococcal cervicitis:

• Many are asymptomatic, but some present with mucopurulent discharge 2
• Leukorrhea (>10 WBC per high-power field on microscopic examination of vaginal fluid) is associated with gonococcal infection 1

Diagnostic Approach

When evaluating a patient with elevated urinary WBC:

• Document urethritis presence using the criteria above (leukocyte esterase test or microscopic examination) 1
• Test specifically for N. gonorrhoeae using nucleic acid amplification tests (NAATs), which are the most sensitive and specific tests available 4, 2
• Simultaneously test for C. trachomatis, as coinfection is common 1, 4
• Gram stain showing WBC containing intracellular Gram-negative diplococci confirms gonococcal infection 1

Important Clinical Pitfall

Do not assume all urethritis with elevated urinary WBC is gonococcal. Nongonococcal urethritis (NGU) is actually diagnosed by the presence of urethral inflammation (including elevated WBC) in the absence of N. gonorrhoeae. 1 C. trachomatis causes 15-55% of NGU cases, and other organisms like U. urealyticum and M. genitalium can also cause urethritis with elevated WBC. 1, 5

Complications if Untreated

Untreated gonococcal urethritis can progress to:

• Epididymo-orchitis 3
• Prostatitis 3
• Disseminated gonococcal infection (0.5-3% of cases) 6
• Rare but serious complications including endocarditis and meningitis 6, 3