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Kidney

Leukocytes in urine in men: what the result does and does not show

Leukocytes in the urine are white blood cells, cells of the immune system that protects the body against foreign invaders. More of them pass into the urine with an inflammation of the bladder or the kidneys, and also with an inflammation of the urethra, for example from an STI.

Pain when passing urine or needing to go often fits a urinary tract infection, and in sexually active men under 65 also a sexually transmitted infection. Immune cells in the urine can only be shown with a urine test.

On the test strip, leukocytes score from negative, the expected result, through trace to +++. In men under 65 with a suspected urinary tract infection, a low risk of complications and no urinary catheter, a negative strip does not reliably rule out an infection according to the UK guidance.

Doctor's Assessment Included

Leukocytes are white blood cells, the cells that fight infection; the leukocyte strip looks in the urine for an enzyme they release, and normally the result is negative.

  • A positive leukocyte strip fits inflammation of the kidneys, bladder or urinary tract, but it is not a diagnosis: nitrite, symptoms and a urine culture count too.
  • The leukocyte strip misses some infections: in studies it was positive in 72 to 97 percent of proven urinary tract infections.
  • Above 65 the leukocyte strip is less reliable, because bacteria and white blood cells in the urine without infection become more common.

Reference Ranges

Expected result Negative

Reference ranges may vary between laboratories. When you order a test, a BIG-registered doctor assesses your personal results in context. For treatment decisions, discuss your results with your GP.

Urine Leukocytes: what this test measures

What the leukocyte strip detects is leukocyte esterase: an enzyme produced by neutrophils, one kind of white blood cell.

The leukocytes themselves are counted under a microscope in a urine sediment, and a urine culture shows whether bacteria grow.

Urine Leukocytes: why this value matters

In men under 65 with a suspected urinary tract infection, a low risk of complications and no urinary catheter, the leukocyte strip serves only to make an infection likely according to the UK primary-care guidance, and a positive nitrite makes an infection more likely.

Bacteria in the urine without infection are rare in men under 65. In sexually active men under 65 with urinary symptoms, the guidance has sexually transmitted infections such as chlamydia and gonorrhoea considered, and an inflammation of the urethra after sex or from irritants.

An STI such as chlamydia can give leukocytes in the urine while the culture grows nothing, which is called sterile pyuria. Other possible explanations include an earlier course of antibiotics, a catheter, stones in the urinary tract, a bladder tumour or tuberculosis of the kidney.

Urine Leukocytes: how the blood test works

Referral
No GP referral needed. After the order we arrange the referral through ZorgDomein, within one business day; orders after 17:00 or at the weekend start on the next business day. ZorgDomein emails a barcode, and that barcode is what the draw site needs.
The draw
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Where
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Urine Leukocytes: when is testing worthwhile?

A urine test for leukocytes fits urinary symptoms such as pain when passing urine or needing to go often or urgently.

Urine Leukocytes: symptoms of a high or low value

Low Levels

A negative leukocyte strip is the expected result; for the diagnosis in men under 65 with a suspected urinary tract infection, a low risk of complications and no urinary catheter, the UK guidance does advise always sending a urine culture, collected before antibiotics are given.

High Levels

In a man under 65 with a positive leukocyte strip, fever or feeling generally unwell next to urinary symptoms is a reason to contact a doctor, because according to the UK guidance it strongly suggests prostate involvement or a kidney infection.

In men under 65, according to that guidance, acute prostatitis may present with a feverish illness of sudden onset. In men under 65 the guidance also lists as possible presentations pain in the lower back, above the pubic bone, in the perineum (the skin between the scrotum and the anus) or sometimes in the rectum, urinary symptoms such as pain, needing to go often, urgency or being unable to pass urine, or a very tender prostate on examination.

Urine Leukocytes: causes of a low or high value

What lowers the value

  • Vitamin C

    Vitamin C in the urine can make the leukocyte strip falsely negative.

  • Concentrated urine, glucose or protein

    Very concentrated urine, or a lot of glucose or protein in the urine, can make the leukocyte strip falsely negative.

  • Some antibiotics

    Some antibiotics, such as nitrofurantoin, tetracycline and gentamicin, can make the leukocyte strip falsely negative.

What raises the value

  • Urinary tract infection

    In a bladder or other urinary tract infection, leukocytes can often be detected in the urine; together with a positive nitrite test they suggest a urinary tract infection.

  • A sexually transmitted infection such as chlamydia

    A sexually transmitted infection such as chlamydia can put leukocytes in the urine while an ordinary urine culture grows nothing.

  • Inflammation without bacterial growth

    Leukocytes in the urine with no growth in the culture can fit, among other things, an earlier course of antibiotics, a catheter, urinary stones or a bladder tumour.

  • Bacteria and white cells without infection in older adults

    Above 65, more and more people have bacteria and white blood cells in the urine without an infection; this can make the leukocyte strip positive, and antibiotics do not help then.

  • Contaminated urine sample

    Urine that was not caught cleanly can make the leukocyte strip falsely positive.

Urine Leukocytes: lifestyle and this value

With leukocytes in the urine and urinary symptoms, also tell the doctor about the sexual history, because the UK guidance has doctors ask sexually active men under 65 about STIs. When a man under 65 has two urinary tract infections in six months or three in twelve months, counting the current one, the same guidance advises referral to a urologist.

Urine Leukocytes: frequently asked questions

What do leukocytes and nitrite in urine together mean in a man?

In men under 65 with a suspected urinary tract infection, a low risk of complications and no urinary catheter, positive leukocytes can point to an inflammation, and above all a positive nitrite makes a urinary tract infection more likely. For men under 65 with a suspected urinary tract infection, a low risk of complications and no urinary catheter, the UK guidance gives a positive predictive value of 96 percent for a positive nitrite: 96 of every 100 of those men with a positive nitrite had a urinary tract infection.

Can an STI cause leukocytes in the urine?

Yes, a sexually transmitted infection such as chlamydia or gonorrhoea can cause leukocytes in the urine. Leukocytes in the urine while the culture grows nothing can fit chlamydia.

Urine Leukocytes: sources

  1. Hitzeman N, Greer D, Carpio E. Office-Based Urinalysis: A Comprehensive Review. Am Fam Physician 2022;106(1):27-35B. (retrieved 2026) aafp.org
  2. Simerville JA, Maxted WC, Pahira JJ. Urinalysis: a comprehensive review. Am Fam Physician 2005;71(6):1153-1162. (retrieved 2026) aafp.org
  3. UK Health Security Agency. Diagnosis of urinary tract infections: quick reference tools for primary care, updated 7 July 2025. (retrieved 2026) gov.uk

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Medical policy
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