A 35-year-old woman reports dysuria. Other than a minor back pain, for which she is

A 35-year-old woman reports dysuria. Other than a minor back pain, for which she is taking ibuprofen, she has generally been healthy. Her vital signs and physical examination are normal. A urine dipstick test reveals 2+ leukocyte esterase. Urine is sent immediately to the laboratory for culture and sensitivity. She is told that she has a urinary tract infection and is given a prescription for trimethoprim-sulfamethoxazole. Two days later, the urine culture report indicates no bacterial growth. In interpreting this report, what should you consider? A. Sterile pyuria may occur in the presence of urinary tract infection if this patient had been self-medicating with an antibiotic. B. Sterile pyuria may be caused by an atypical organism such as Chlamydia trachomatis, U. urealyticum, or Mycobacterium tuberculosis. C. Obtain further history regarding her analgesic intake and consider chronic interstitial nephritis in the differential. D. All of the above.

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