Unresolved Pyuria

In this review, the most recent literature regarding causes of sterile pyuria and the conditions that can co-occur or present with sterile pyuria will be addressed. Specifically, we examine sterile pyuria in the context of genitourinary tuberculosis, sexually transmitted infections, interstitial cystitis, and genitourinary malignancy. Newer diagnostic technologies such as next-generation sequencing (NGS) have shown that urine may not truly be sterile. Unresolved pyuria (i.e., pyuria without identifiable cause) may therefore be caused by sub-clinical infections or the result of underlying changes in the urinary microbiome. While sterile pyuria classically refers to the absence of bacterial growth under traditional methods, newer diagnostic technologies have allowed us to challenge and revisit this definition.