Leukocytes in urine in men: what the result points to

The pad detects leukocyte esterase, an enzyme from neutrophil granulocytes. Those cells are the most numerous in acute inflammation. So the pad measures not the cell, but its trace.

That explains why the pad can read positive while the sediment counts few intact cells. The cells have broken apart. This is not a measurement error, but precisely what an enzyme pad is for.

In men the question is rarely whether this is a bladder infection. The question is where the inflammation sits. The pad does not distinguish that. Inflammation of the urethra, the prostate and the bladder all produce leukocytes in urine.

The combination with the other pads does point in a direction:

The result is semi-quantitative and carries no unit. The scale follows the amount of enzyme, not the severity. The combination therefore says more than the score itself.

In men the key question is not whether there is inflammation, but where it sits. That changes what the result is worth.

The pad is sensitive and not very specific. A positive result alone therefore proves little. The combination does the work.

A positive nitrite test is insensitive but highly specific. Nitrite appears when gut bacteria convert nitrate. Leukocytes and nitrite in urine together, with symptoms, make a bacterial bladder infection likely.

Leukocytes without nitrite is the more interesting pattern in men. Not every organism converts nitrate. And the organisms that do not are precisely the ones causing urethritis. Chlamydia and gonorrhoea produce leukocytes in urine while the ordinary culture grows nothing.

That pattern is called sterile pyuria. Take a sexually active man with burning and a negative culture. An STI test is then the logical step. Not another urine test. Other explanations are kidney stones, prostatitis, and an interstitial nephritis caused by medication.

There is another reason not to be reassured too quickly in men. A urinary tract infection in a man counts as complicated. The cause more often lies in drainage: an enlarged prostate, a stone, or incomplete emptying. If urine is left behind, bacteria in the urine get more opportunity. And from the bladder they can reach the kidneys through the ureters.

This pad alone cannot establish that. A positive result in a man is therefore almost always a reason for further investigation. Even without severe symptoms.

Have this test done for urinary tract symptoms. It means pain or a burning sensation when passing urine. Also going more often, urgency and a weak stream. Lower abdominal pain counts as well. It also belongs with discharge from the urethra, alongside an STI test.

How you collect determines how usable the result is. Collect midstream urine: let the first stream run and only then collect. That first stream flushes away the bacteria that entered the bladder through the urethra. Those say nothing about the bladder itself. Clean the area first. With an uncircumcised penis, retract the foreskin.

A morning sample is the most concentrated. Deliver it to the lab within two hours or keep it refrigerated.

If you suspect an STI, time the test to the start of symptoms. So not once you have already started a course of antibiotics. For the STI test itself a first-void sample is in fact the right one. That is a different test from this one.

With fever, chills, flank pain or perineal pain, make contact the same day. See also the wider urine screen of which this test forms part.