A routine urine dipstick shows WBCs and many epithelial cells. Next step?

A routine urine dipstick shows WBCs and many epithelial cells. Next step?

• A. Nothing because a few WBCs and epithelial cells are to be expected in this type of urine
• B. Refer the patient to a urologist
• C. Send this urine specimen for a culture and sensitivity test
• D. Ask the patient to clean peri-genital area and Repeat the dipstick with a clean catch urine specimen

Answer: (D)

A clean-looking urine sample is essential to reliably interpret a dipstick. When many epithelial cells are seen, it often indicates contamination from skin or peri-genital flora rather than urine from the bladder. This contamination can falsely elevate leukocyte (WBC) counts, making it hard to tell if there’s a true urinary tract infection. Therefore the best next step is to guide the patient to clean the peri-genital area and collect a clean-catch midstream urine specimen, then repeat the dipstick. A properly collected sample minimizes contamination, so a true signal of pyuria or infection can be discerned. If, after a clean catch, leukocytes remain and symptoms persist, consider sending the specimen for culture and sensitivity to identify the specific organism and appropriate antibiotic, or pursue further evaluation if there are red flags.

A clean-looking urine sample is essential to reliably interpret a dipstick. When many epithelial cells are seen, it often indicates contamination from skin or peri-genital flora rather than urine from the bladder. This contamination can falsely elevate leukocyte (WBC) counts, making it hard to tell if there’s a true urinary tract infection.

Therefore the best next step is to guide the patient to clean the peri-genital area and collect a clean-catch midstream urine specimen, then repeat the dipstick. A properly collected sample minimizes contamination, so a true signal of pyuria or infection can be discerned. If, after a clean catch, leukocytes remain and symptoms persist, consider sending the specimen for culture and sensitivity to identify the specific organism and appropriate antibiotic, or pursue further evaluation if there are red flags.