Seeking Guidance: Positive Nitrates but Negative for Leukocytes
I am a 23-year-old female, standing at 5'2" and weighing 108 pounds. I have a mixed ethnic background of Caucasian and Hispanic and reside in the United States. My nicotine use includes vaping, but I do not consume alcohol. For about a year and a half, I've been taking Prozac at a dosage of 40 mg and have also been on a low-dose birth control pill, Northedrione 0.35 mg. Currently, I find myself somewhat lost regarding my health situation. My primary complaint involves an urgent need to urinate and occasional leakage, which has intensified over the last year. Fortunately, I don't experience burning sensations or pain while urinating; however, I do struggle with significant fatigue, often requiring more than 10 hours of sleep and feeling the need to nap frequently. I've also been encountering sudden shooting pains in my hands and numbness in my feet, along with headaches that have evolved into more severe migraines, particularly behind one eye. These headaches have become more enduring than in the past. Recently, I underwent urinalysis followed by a culture. The test results indicated a normal pH level, but showed the presence of protein, ketones, and nitrates in my urine. There were trace amounts of bilirubin and urobilinogen noted as well, but leukocytes were absent. It's worth mentioning that the urine sample was relatively small, under 30 ml. Upon further investigation through the culture, it revealed a high concentration of E. Coli, along with a small presence of mixed bacteria. What could these findings imply? I have mostly come across information concerning the presence of leukocytes combined with a lack of nitrates, rather than the other way around. It’s clear to me that I’m experiencing an infection, but I’m perplexed about the absence of leukocytes, especially given the severity of my symptoms. Apart from that, the only other abnormal lab result I received was related to my vitamin D levels, which have shown a decline upon retesting over a couple of months. I have undergone various tests for allergies, autoimmune disorders, and arthritis, including routine blood panels like a CBC, as well as thyroid and B12 assessments. My primary care physician has referred me to a urologist and has prescribed antibiotics for my condition.
Answers (1)
7/25/2025, 11:31:02 PM
OpenHealth AI
Your symptoms and test results indicate a urinary tract infection (UTI) caused by E. coli, though it's understandable to be unsettled by the absence of leukocytes in your urine. Let's break down the essential points and next steps for you.
Key Points:
- Positive Nitrates & E. coli: The presence of nitrates and the identification of E. coli in your urine culture suggest a bacterial infection, typical of a UTI.
- Absence of Leukocytes: While leukocytes (white blood cells) are commonly present in urine during an infection, their absence can occur, particularly in early infections or less severe cases. Your symptoms still strongly point toward an infection.
- Fatigue and Other Symptoms: The fatigue, migraines, and nerve-related symptoms can be linked to various causes and could be exacerbated by the infection, medication, or vitamin D deficiency.
Explanation:
Nitrates convert to nitrites in the presence of certain bacteria, like E. coli, which is why you tested positive. The absence of leukocytes doesn’t rule out an infection but may suggest that your immune response is not as active at this time.
Next Steps:
- Follow Treatment Plan: Continue taking the antibiotics prescribed by your physician to address the infection. It's crucial to complete the entire course, even if symptoms improve.
- Hydration: Increase your water intake to help flush out the bacteria and improve your urinary function. Aim for at least 8-10 glasses of water daily.
- Monitor Symptoms: Keep track of any changes in your symptoms. Note if the urgency or leakage worsens, or if you develop new symptoms such as fever or flank pain, which would require immediate attention.
- Vitamin D Levels: Discuss with your healthcare provider potential vitamin D supplementation to address your declining levels. Low vitamin D can contribute to fatigue and other systemic issues.
- Follow Up with Urologist: During your urology appointment, discuss all your symptoms, including the fatigue, migraines, and nerve-related issues. They may perform additional tests to ensure a comprehensive approach to your health.
By focusing on these steps and maintaining open communication with your healthcare team, you can work toward improved management of your symptoms. It’s important to prioritize your overall health and seek support as needed; you’re taking the right steps by seeking clarity on your situation.
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