White Blood Cells in Urine: What Your Result Means
Medically Reviewed by Dr. Pedro Yelamo Vera, MD
Licensed Physician No. 484814280 · Official Medical College of Bizkaia (Spain)Last reviewed: 31 October 2026
White blood cells in urine often mean a UTI, but not always. What leukocytes on a dipstick mean, other causes, and when to see a doctor today.
You don't have to figure this out alone
Dr. Pedro Yelamo Vera is an independent, bilingual GP licensed in Spain. Book a 15-minute video consultation in English or Spanish for €50, with a private electronic prescription issued under Spanish law when clinically appropriate.
White blood cells in urine usually mean something is inflamed in the bladder or urinary tract. The commonest cause is a urinary tract infection (UTI). But a positive result is not proof of infection. Skin or vaginal discharge in the sample, a recent infection, a sexually transmitted infection or some medicines can cause it too.
- On a dipstick, a negative white cell (leukocyte esterase) test is normal. Each lab sets its own limit for the microscope count.
- The commonest cause is a UTI, mainly when you also have burning, urgency or a positive nitrite test.
- White cells with no symptoms often need no antibiotics, especially in people over 65 or with a catheter.
- White cells with no bacteria on culture is called sterile pyuria. It has its own list of causes.
- Fever, shivering or pain in your back under the ribs need a doctor today.
Dr. Pedro Yelamo Vera is a GP licensed in Spain (Colegiado No. 484814280).
For a medical emergency, call 112 or go to the nearest local emergency department. Do not wait for a video consultation or an online reply.
What is a normal result for white blood cells in urine?
There are two ways to look for white cells. The first is a dipstick. MedlinePlus explains that a pad on the strip changes colour when white cells are present. This is the leukocyte esterase test. A negative result is normal. If it is positive, the urine is often checked under a microscope.
MedlinePlus lists white cells among the things not normally found in urine. In practice, a few are common. A practical guide in the British Journal of General Practice (BJGP) treats more than 5 to 8 white cells per high-power field as raised. Labs vary, so read the range printed next to your result.
What will I see on a Spanish, UK or US urine report?
- Spain: the test is often called sistemático de orina or análisis de orina. The strip shows leucocitos or esterasa leucocitaria, often in crosses (+ to +++). The microscope part is the sedimento, with white cells per field (por campo) or per microlitre. Nitritos are nitrites. The culture is the urocultivo.
- UK: the GP usually starts with a dipstick. A midstream sample (MSU) goes to the lab for culture when needed.
- US: the test is a urinalysis (UA). Many labs add a culture if the first test is abnormal.
The word for many white cells in urine is pyuria, or piuria in Spanish. Units differ between labs, so compare like with like.
What causes white blood cells in urine?
Infection is the usual reason, but not the only one. The BJGP guide and MedlinePlus list these causes:
- Bladder infection (cystitis): the commonest cause.
- Kidney infection: often with fever, shivering and pain in the back or side.
- A contaminated sample: vaginal discharge, blood or heavy mucus can make the strip positive.
- Sexually transmitted infections: chlamydia is the commonest one found in younger, sexually active people. Trichomonas can also turn the strip positive.
- A UTI treated in the last two weeks: white cells can linger after the germs have gone.
- Kidney stones, catheters or stents.
- Some medicines: anti-inflammatory painkillers such as ibuprofen, aspirin, acid-reducing tablets (PPIs), water tablets (diuretics) and some antibiotics.
- Pregnancy and the changes after menopause.
- Rare causes: kidney tuberculosis or a tumour in the urinary tract.
Do white blood cells in urine mean I have a UTI?
Not always. A doctor reads them with your symptoms and the nitrite result. Typical UTI symptoms, says the NHS, are pain or burning when you pee, needing to go often or urgently, cloudy pee, blood in the pee and lower tummy pain.
UK guidance from the UK Health Security Agency reads the dipstick like this for women under 65:
- Nitrite positive, or white cells and blood both positive: a UTI is likely.
- White cells positive, nitrite negative: a UTI is about as likely as another cause.
- All negative: a UTI is less likely. The doctor looks for another cause.
The same guidance says 75% to 80% of people with vaginal discharge do not have a UTI. In men, a negative dipstick cannot rule out infection, so a sample goes for culture. A review in American Family Physician adds that cloudy urine often comes from harmless crystals, not only from white cells.
Got a urine result with leukocytes and not sure what it means?
You can book a video visit with a GP licensed in Spain, in English or Spanish. He reads the whole report, asks about your symptoms, and explains whether you need a culture, another test or treatment.
What if I have white cells but no symptoms?
This is common and often needs no treatment. UK guidance says not to use dipsticks in people over 65. By age 80, about half of older adults in care homes have bacteria in their urine without infection. Most people with a catheter for over a month do too. Antibiotics do not help them.
The US Preventive Services Task Force agrees: it advises against screening adults who are not pregnant. Pregnancy is the exception. The Task Force advises a urine culture in pregnancy, and Spanish public health advice does too. UK guidance says to treat any bacteria found in pregnancy, even without symptoms.
What is sterile pyuria?
Sterile pyuria means white cells in urine with no bacteria growing on culture. The BJGP guide says 9% of people seen by their GP for a suspected UTI turn out to have it. Common reasons are a recently treated UTI, chlamydia, stones or a medicine.
The first checks are simple. A doctor asks about sex, travel and medicines, repeats a clean sample and culture, and may test for chlamydia and gonorrhoea. Blood tests for the kidneys, or a kidney ultrasound, follow if the cause is still unclear.
What about white cells in a child's urine?
Children often have vague symptoms. The NHS lists fever, wetting, being sick and, in babies, being irritable and not feeding. The UK guideline for under 16s (NICE NG224) reads the dipstick in children aged 3 and over like this:
- White cells and nitrite both positive: treat as a UTI.
- White cells positive, nitrite negative: send the urine for microscopy and culture. Antibiotics only if there is good clinical evidence of a UTI.
- Both negative: a UTI is unlikely.
NICE refers babies under 3 months with a suspected UTI to a children's specialist team. In Spain, that means taking them to a children's emergency department (urgencias de pediatría) straight away.
How do I give a good urine sample?
- Use a clean-catch, midstream sample. Start to pee in the toilet, then fill the pot.
- Take it to the lab soon. A review in American Family Physician says the sample should be checked within two hours.
- Tell the lab if you have your period or heavy discharge. Both can make the strip positive.
- Mention vitamin C supplements. MedlinePlus says high vitamin C or protein can hide a positive result.
When should I get help today?
See a doctor today if you have white cells in your urine and any of these:
- Fever, shivering or pain in your back or side under the ribs.
- Being sick, or feeling very unwell.
- Urine symptoms while pregnant, in a man, or in a child.
- Symptoms that get worse fast, or do not improve 48 hours after starting treatment.
Call 112 if someone is confused, very drowsy or has trouble speaking. These signs can mean a serious infection.
One more difference for visitors: in parts of the UK, a pharmacist can treat a simple UTI in some women aged 16 to 64. In Spain, antibiotics for a UTI need a doctor's prescription. Our UTI care page explains how that works.
Talking it through with a doctor by video
Dr. Yelamo is a GP licensed in Spain. He sees adults, children and pregnant patients by video, every day from 07:30 to 20:30 (Spain time). In the visit he will:
- Read your full urine report: the strip, the sediment and any culture.
- Ask about your symptoms, sex life, pregnancy and the medicines you take.
- Explain whether you need a culture, a repeat sample, an STI test or treatment.
- Tell you when you need an exam in person.
He does not promise any test or prescription before the visit. Where clinically appropriate, following a genuine evaluation. Treatment and prescriptions are issued solely at the doctor's discretion based on evidence-based clinical guidelines.
A prescription is never guaranteed: it is issued only where clinically appropriate after a genuine evaluation, as a private electronic prescription under Spanish law. This service is for urgent, non-emergency care. In an emergency, call 112.
See how the Urgent Care video visit works. It lasts 15 minutes and costs €50.
This guide is general information. It does not replace a consultation with your doctor.
Frequently asked questions
Is it bad to have white blood cells in urine?
Not always. It often means a urinary infection, but a contaminated sample, a recent infection, an STI or some medicines can also cause it. Your symptoms decide what happens next.
What does leukocytes +1 or +2 on a urine test mean?
The strip found white cells. More crosses mean more cells. A doctor reads it with the nitrite result and your symptoms, and may send a culture.
Can I have white cells in urine without an infection?
Yes. This is called sterile pyuria. Common causes are a UTI treated in the last two weeks, chlamydia, kidney stones and some medicines.
Do white cells in urine need antibiotics?
Only if there is an infection that needs treating. White cells with no symptoms usually need no antibiotics, except in pregnancy.
Can my period affect a urine test?
Yes. Blood or heavy discharge can make the strip positive. Tell the lab, or repeat the test after your period if it is not urgent.
What is leucocitos en orina on a Spanish report?
It means white cells in urine. You may also see esterasa leucocitaria, nitritos, sedimento and urocultivo, which is the urine culture.
Sources
- MedlinePlus: Leukocyte esterase urine test
- UK Health Security Agency: Diagnosis of urinary tract infections
- NHS: Urinary tract infections (UTIs)
- NICE NG224: Urinary tract infection in under 16s
- US Preventive Services Task Force: Asymptomatic bacteriuria screening
Related guides
Medical Citations & Sources
This content is written and reviewed by a licensed physician with reference to the following official health authorities.
