Leukocytes, more commonly known as white blood cells (WBCs), help the body fight infection and disease. Small amounts of leukocytes in the urine is normal, but higher levels can indicate an underlying condition. One question that arises is whether the presence of leukocytes in urine could point to a sexually transmitted disease (STD). In this article, we’ll explore the connection between leukocytes and STDs, looking at what leukocytes do, what causes them to show up in urine, and whether they can signify an STD.
What are leukocytes?
Leukocytes, or white blood cells, are an important part of the immune system. There are several types of leukocytes, including:
- Lymphocytes: Help fight viral, bacterial, and fungal infections
- Monocytes: Swallow up bacteria and dead cells
- Granulocytes: Release enzymes to fight infection
- Basophils: Release histamine and other chemicals that cause inflammation
Leukocytes circulate in the blood stream and lymph system, acting as the body’s defenders against illness and infection. They identify and neutralize pathogens like bacteria and viruses. An increase in leukocytes occurs when the body is fighting an infection or other inflammatory condition.
Normal leukocyte levels
A normal white blood cell count is somewhere between 4,500 and 11,000 WBCs per microliter of blood in adults. Newborns often have slightly higher leukocyte counts. Values outside the normal range could indicate:
- Leukopenia: A WBC below 4,500 per microliter
- Leukocytosis: A WBC above 11,000 per microliter
Small variations in the WBC are common and not typically a major concern. Larger increases or decreases that persist could point to an underlying problem.
What causes leukocytes in urine?
A small number of leukocytes in urine is normal. However, higher concentrations could signal inflammation, infection, or damage within the kidneys or urinary tract. Potential causes include:
Urinary tract infections
One of the most common causes of leukocytes in the urine is a UTI, such as cystitis or urethritis. The immune system dispatches leukocytes to the kidneys and urinary system to fight off the infection. This leads to an elevated leukocyte count in urine of usually more than 15 WBCs per high power field when viewed under a microscope.
Kidney disease
Damaged or inflamed kidneys can cause leukocytes to end up in the urine. Examples include acute or chronic kidney infections, kidney stones, and glomerulonephritis, an inflammation of the kidney’s filtration system. Interstitial cystitis, inflammation of the bladder wall, can also lead to leukocytes in the urine.
STIs
Sexually transmitted bacterial infections like gonorrhea and chlamydia can cause inflammation of the urethra, leading to pus and leukocytes in the urine. Viral STIs like genital herpes generally don’t cause an increase in urine leukocytes.
Prostatitis
An inflamed or infected prostate gland can release leukocytes that get expelled into the urine.
Strenuous exercise
Intense physical activity can temporarily raise the leukocyte count. The leukocytes should return to normal within a day or two after an intense workout.
Damage to the urinary tract
Injury, urinary catheters, kidney stones, or tumors that irritate the lining of the urinary tract allow leukocytes to seep into the urine.
Other causes
Less common causes of elevated urine leukocytes include radiation therapy, chemotherapy, autoimmune disorders like lupus, and certain medications.
Can STDs cause leukocytes in urine?
Some sexually transmitted diseases like chlamydia and gonorrhea can lead to leukocytes in the urine. However, the presence of leukocytes alone does not definitively indicate an STD. Let’s look more closely at the link between urine leukocytes and common STDs:
Chlamydia
The bacteria Chlamydia trachomatis frequently infect the urethra, cervix or urinary tract, especially in women. This triggers inflammation and leukocytes as the body tries to fight off the infection. More than 50% of women with chlamydia have leukocytes in their urine.
Gonorrhea
Similar to chlamydia, the bacteria Neisseria gonorrhoeae often infects the urethra and/or cervix, causing discharge and leukocytes in the urine as white blood cells rush to the site of infection. Over half of gonorrhea infections can be detected through a urine leukocyte test.
Trichomoniasis
The parasite Trichomonas vaginalis causes trichomoniasis, a common STD. In women, trichomoniasis is associated with leukocytes in about 6-52% of cases. The wide range is due to other factors like simultaneous bacterial vaginosis also causing leukocytes.
Genital herpes
The herpes simplex viruses HSV-1 and HSV-2 predominantly cause sores and skin inflammation. Without open sores present, herpes does not generally cause leukocytes in urine.
HIV/AIDS
HIV does not directly infect the urinary tract, so the virus does not cause leukocytes. However, HIV can increase susceptibility to UTIs that then produce leukocytes. AIDS can also allow for secondary infections that spread to the urinary system.
Hepatitis B
While the hepatitis B virus (HBV) primarily targets the liver, in rare cases it can cause glomerulonephritis kidney inflammation that releases leukocytes into urine. This occurs in less than 1% of acute HBV infections.
HPV
The human papillomavirus (HPV) causes cellular changes and genital warts but does not directly infect the urinary tract. So HPV alone does not cause leukocytes in urine.
When to see a doctor
While minor urine leukocyte elevations may resolve on their own, it’s a good idea to see a doctor if you have these risk factors:
- Significant urinary symptoms like burning during urination, pelvic pain or urgent/frequent urination
- Exposure to an STD through unprotected sex
- Presence of leukocytes along with other symptoms like fever, back pain or foul-smelling urine
- Persisting leukocytes in multiple tests spread out over 1-2 weeks
- Additional symptoms like vaginal discharge or sores in the genital region
- A compromised immune system due to medication, HIV/AIDS, chemotherapy, etc.
Your primary care provider or urologist can help determine the underlying cause through evaluation and testing. A urinalysis looks at urine color, smell, and microscopic contents like leukocytes, blood, or bacteria. A urine culture specifically identifies any microorganisms present. Doctors can also test for STDs through cervical or urethral swabs. Pelvic exams check for discharge, inflammation and other abnormalities.
Can a urine leukocyte test detect STDs?
A urine leukocyte test alone cannot definitively diagnose an STD. While it can strongly suggest an infection like chlamydia or gonorrhea, further testing is needed to confirm the specific infection. Key points:
- A positive leukocyte esterase urine test indicates elevated white blood cells, which could signal an STD.
- But leukocytes can also be caused by a non-STD UTI, kidney issues, vigorous exercise, etc.
- Doctors use additional urine tests and STD tests to identify the specific cause.
- A urine leukocyte test may prompt further STD testing if infection is suspected.
So in summary, the presence of leukocytes in urine cannot provide a conclusive STD diagnosis. But significantly high leukocytes, especially with other STD-suggestive symptoms, do warrant follow-up STD testing. A combination of medical history, physical examination and diagnostic testing guides the doctor’s decision-making.
Treating leukocytes in urine
The appropriate treatment depends on the underlying cause of the elevated urine leukocytes.
Antibiotics for infections
If a bacterial infection like urethritis or cystitis is causing the leukocytes, antibiotics are used to clear the infection. Usually a 7-14 day course resolves the problem. Your partner will also need treatment to prevent reinfection.
Medications for other causes
For recurring kidney stone formation, medications can help change urine composition to discourage stones. Interstitial cystitis may improve with instilled bladder medications. Enlarged prostate symptoms improve with alpha blockers or dutasteride. Still other causes like autoimmune disorders may require immunosuppressants.
Address high-risk behaviors
Practicing safe sex with condoms, limiting sexual partners, and prompt STD testing and treatment if exposed can help prevent recurrent STDs that create leukocytes. Good hygiene and wiping front-to-back after using the bathroom are also beneficial.
Avoid irritants
Soaps, chemicals, douches, and feminine hygiene sprays can irritate the urethra and bladder, make underlying problems worse. Wearing cotton underwear and avoiding potentially irritating products promotes healing.
See a urologist or nephrologist
For recurring or complex urinary tract problems, seeing a specialist like a urologist or nephrologist may be warranted. They can perform more extensive testing and provide advanced treatments.
Can leukocytes go away on their own?
Mild or transient elevations in urine leukocytes may go away spontaneously. More significant or persistent leukocytes usually require treatment of the underlying condition. Some key points:
- A one-time spike in leukocytes after strenuous exercise may resolve quickly.
- Mild dehydration leading to concentrated, leukocyte-filled urine improves with hydration.
- Mild UTIs may clear with good hydration and urination.
- But untreated bacterial STIs like chlamydia/gonorrhea won’t resolve without antibiotics.
- Significant leukocytes from kidney disease also require proper treatment.
In most cases, persistent leukocytes don’t just go away on their own. Seeing your doctor for evaluation is important, both for symptom relief and to prevent complications. With appropriate treatment guided by a definitive diagnosis, leukocytes should resolve.
Takeaways
Let’s review some key points about the connection between leukocytes in urine and STDs:
- Leukocytes are white blood cells that fight infection and signal inflammation.
- Small amounts of leukocytes in urine is normal, but higher levels indicate illness.
- UTIs, kidney disease, STIs, vigorous exercise, tumors and other conditions can cause urine leukocytes.
- Bacterial STIs like chlamydia and gonorrhea can specifically lead to leukocytes.
- But leukocytes alone don’t definitively diagnose STDs – further testing is required.
- Treatment depends on the cause, but may include antibiotics, medication, lifestyle changes.
- Seeking medical care for persistent leukocytes is important to relieve symptoms and avoid complications.
While leukocytes in the urine can be concerning, try not to worry excessively until evaluated. Your doctor can help determine the cause and ensure you get the proper treatment to resolve any underlying condition.
Conclusion
Leukocytes are white blood cells that enter the urine in response to infection or inflammation. While UTIs are a common cause, STDs like chlamydia and gonorrhea can also produce leukocytes during a urinary tract infection. However, urine leukocytes alone cannot definitively diagnose an STD. Doctors must perform additional testing to identify the specific infection responsible. With appropriate diagnosis and treatment, typically with antibiotics, the leukocytes should subside as the condition improves. While mild leukocyte elevations may resolve spontaneously, recurrent or excessive levels warrant medical attention to relieve symptoms, address the root cause and prevent possible complications.