[Question #3525] Abnormal Urine Leukocyte Esterase result

34 months ago
Hi Dr HHH/Dr Hook,

I had been feeling random discomfort/pain in my urethra and penis. The pain is there for a few seconds and then goes away. Today I saw that there were some red spots/blotches near my meatus opening (on the inside) and went to see the doctor. She said that it looked just some redness to her and nothing concerning. I was worried about Herpes or other STI, she ordered a urinalysis test. I just received the results online- the Leukocyte Esterase is marked as 'Trace' and 'Abnormal' in the results and mucous is marked as 2 +. Does this signify urethral herpes or another STI?  Following are results for your reference: 


ComponentYour ValueStandard RangeFlag
Urine ColorYellow   
Urine AppearanceClear   
Urine Specific Gravity1.026  1.003 - 1.035
Urine pH6.0  5.0 - 8.0
Urine Leukocyte EsteraseTrace  NegA
Urine NitritesNeg  Neg
Urine ProteinNeg  Neg
Urine GlucoseNeg  Neg
Urine KetonesNeg  Neg
Urine Urobilinogen1+ EU/dL0 - 2 EU/dL
Urine BilirubinNeg  Neg
Urine BloodNeg  Neg
Urine White Blood Cells0-2 /(hpf)0 - 5 /(hpf)
Urine Red Blood Cells0-2 /(hpf)0 - 2 /(hpf)
Urine Mucous2+ /(lpf)/(lpf)

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
34 months ago
Welcome back, but sorry you found it necessary.

Thesea re entirely normal results. Mucus in urine simply means the urine washed out a little mucus in your urethra; or pre-ejaculate fluid. And 0-2 WBC (or 0-2 WBC) are entirely normal. For sure neither these results nor your symptoms suggest herpes or any other urethral infection.

Please re-read my comments in your previous thread. With calm interpretation, you'll understand that my reassurance that you were not at risk was reasoned, science based, and entirely valid. In the event you turn up with some STD or other definite lower urinary tract or genital problem, you can be 100% sure it was not something you caught from the events described there.

34 months ago
Thank you so much, Dr. HHH.

I have been re-reading your response to my last question, as well as your and Dr. Hook's responses to other similar questions in this forum, and that has been the only thing which calms me down.
1. Is it also normal to have 'trace' of leukocyte esterase in the urine, even with the clean catch sample ? I think I might not have given the perfect 'clean catch' sample to the nurse yesterday ( it was not mid-stream urine) , not sure if that contributed to the results.

My only other sexual exposures in the last 4 months have been an unprotected Oral and unprotected breast sex (rubbing penis between the breasts) with masturbation.  I was tested for common STIs after the Oral sex exposure (in Jan) and was tested for Herpes IGG last week. (HSV1 is positive, which I have had since childhood).

My problems started last year when I had protected sex and unprotected breast sex after almost 5 years of abstinence. I developed a fungal infection soon after and then irritation towards the end of head of my penis.  I tested negative for all STIs even 3 months after the exposure. Since then, the irritation (or erosion) has persisted. It goes down but again becomes worse. Similarly, the opening near my urethra and the frenulum now becomes red and elevated after ejaculation. It doesn't hurt but becomes red and swollen. For the skin issues, I have been working with a good dermatologist, but we are not yet able to determine the root cause for this. I had read a very similar question by another user on this forum, but am not able to search it now. I have had many other 'bumps' and 'pimples' in boxer shorts area, but I have had them looked by doctors every time and they told me it's not Herpes. Second issue has been the intermittent urethral irritation/pain and random pains in my genitals, which started mostly after the Oral sex exposure. I had pain during urination only after ejac. for few days, but urine tests came out normal. This pain is not constant. I live in the Bay Area, and getting a urologist appointment at good places like Stanford takes upto 2-3 weeks, and by the appointment, the symptoms die down.

1. Have you had patients with similar random symptoms after a new sexual exposure, but negative STI tests?
2. In your opinion, do I need testing for something? Should I work with a Urologist for this?
3. I feel like my life has been on hold for more than 6 months now. I have decided to start counseling at integrated medicine center at Stanford, to help me move ahead. But my main concern is if I will be putting my future partner at risk for any infections? I want to start a committed relationship, but I have been led into this vicious cycle of symptoms and then new exposures. ( I can't find a better way to explain this- reminds me of the Dentist poem by Ogden Nash :) ) 

34 months ago
Last Sept/Oct.- Protected sex and unprotected breast sex
Last Dec end - 10 panel STI negative

Jan- Unprotected Oral
Jan mid- Chlam./Gonnorhea/Ureaplamsa/Mycoplasma neg, Macroscopic Urinalysis normal
March- Unprotected breast sex, protected vaginal sex (described in last question)
March end- Negative HSV IGG for HSV2, HSV1 positive, urinalysis results shared in this post

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
34 months ago
"Is it also normal to have 'trace' of leukocyte esterase in the urine?" Yes, happens all the time. It means the same thing as 0-2 WBC in the urinalysis -- i.e. nothing. This sort of urinalyisis finding is always ignored.

"Have you had patients with similar random symptoms after a new sexual exposure, but negative STI tests?"  Identical answer: this happens a lot. Just read any 10-20 threads on this forum at random for stories similar to your.

"do I need testing for something? Should I work with a Urologist for this?" I see no need for either. If you decide to see a urologist, understand that the intent is for confirmation that nothing physical is wrong, at least nothing important to your health. (Uncircumcised men often get balanitis, i.e. minor inflammation of the head of the penis and under the foreskin. It's virtually never due to STD.)

Counseling, risk for partners, etc:  You cannot infect a partner with anything you do not have -- and clearly you have no STD. Period, full stop. Counseling probably is a good idea, if it will help you accept the reasoned, science based reassurance you have had from us and perhaps your own doctor(s) -- and to get past the vicious cycle you describe, which is a very accurate and insightful description of your problem.

Finally, I'm especially glad you'll be seen at Stanford. The Stanford Dept of Urology is a world leader in male chronic pelvic pain syndrome (google that phrase and you'll see info from Stanford pretty high on the sites identified). CPPS isn't exactly what you have, but CPPS and genitally focused anxiety are very closely related. I think you'll find their evaluation and advice very helpful.
34 months ago
Thank you so much for the detailed responses, Dr. Handsfield.

The last time I saw a RN at Stanford Urology (in Jan), she did mention CPPS and had asked me to rely on things like sitz baths etc. for the urethral pain I was observing at the time. It had gone away, so I did not follow up later, as per her suggestion.

I am still seeing sort of red splotches near my urethral meatus opening (on the inside), and I think they were not present in Jan. the last time I had visited Urology. I showed the spots to a GP and she said that it doesn't look concerning to her. But today when I tried to poke them with a q-tip, it hurt even with a very mild touch. Is urethral opening meatus supposed to hurt with a touch like this? Also I am having pain in my left butt and leg intermittently which adds to my worry.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
34 months ago
This still doesn't sound like any STD, and with your GP (and probably the Stanford nurse) telling nothing is wrong, I'm confident that is the case. I believe you're hypersensitive to both the appearance of your urethra and its apparent sensitivity, due to your anxiety. I strongly suggest you stop all self examaination. (And what in heaven's name were you thinking in poking yourself with a Q tip?) You clearly have no STD -- and that's the only topic for this forum.

That completes this thread. Please note the forum does not permit repeated questions on the same topic or exposure. This will have to be your last one; future new questions about your penile symptoms and your fears about STDs will be not receive a reply and the posting fee will not be refunded. This policy is based on compassion, not criticism, and is designed to reduce temptations to keep paying for questions with obvious answers. In addition, experience shows that continued answers tend to prolong users' anxieties rather than reducing them. Finally, such questions have little educational value for other users, one of the forum's main purposes. I trust you will understand.

I do hope this discussion and your previous one have been helpful.