Are pus cells always present in urine in case of a UTI?

Q: I am a 37 years-old male. I have symptoms of a urinary tract infection like frequency, urgency and dysuria but there are no pus cells in the urine. Is it possible to have an infection without the presence of pus cells in the urine?

A:While UTI is classically associated with frequency, urgency and dysuria, such symptoms are not necessarily due to UTI all the time. Chronic prostatitis, stone disease of bladder or lower ureter, and urinary bladder CIS (carcinoma in situ) are some examples of non-infective diseases producing similar symptoms. Genitourinary tuberculosis also presents itself with similar symptoms. Chronic prostatitis (now rechristened as CPPS or chronic pelvic pain syndrome, since it is now agreed to be non-bacterial in origin) is one entity with all symptoms described by you, and normal urinary findings. All other mentioned diseases will have significant associated pyuria (increased pus cells in urine). You must, thus, realise that all urinary symptoms are not due to UTI,and similarly every person with pyuria is not suffering from UTI. You need to see a specialist instead of deriving your own conclusions.