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Nitrite in Urine: A Comprehensive Guide

Updated: Jun 10


Diagnosing Nitrite in Urine.

Knowing about nitrites in urine is important for maintaining good health. Nitrites are chemical compounds that can be found in urine and can be a sign of various health conditions. This article will explain what nitrite in urine is, what causes it, related health issues, the key points of testing, treatment, and prevention.


What is Nitrite in Urine?

Nitrite in urine is a chemical that forms when bacteria change nitrate, a substance found in urine, into nitrite. Nitrite is not usually found in urine, and if it is found, it can be a sign of potential health issues, especially those related to the urinary tract.


What Causes Positive Nitrite in Urine?

Positive nitrite results in a urine test usually mean there is a bacterial infection in the urinary tract. However, there are other things that can cause nitrites to be present in your urine. This guide explains these causes in detail to give a clear understanding of what might be causing them.


1. Urinary Tract Infections (UTIs)

The most common cause of positive nitrite results in urine is a urinary tract infection (UTI). These infections happen when bacteria get into the urinary tract and start to grow. These bacteria can change nitrates in the urine into nitrites. The most common bacteria that cause UTIs are:


  • Escherichia coli (E. coli): This bacterium causes most UTIs, especially in women. E. coli normally lives in the intestines but can cause infection if it gets into the urinary tract. E. coli has an enzyme that allows it to change nitrates into nitrites, which can cause positive nitrite test results.

  • Klebsiella and Proteus species: These bacteria can also change nitrates into nitrites. They're not as common as E. coli, but they can still cause serious urinary tract infections.

  • Other Gram-negative bacteria: Other bacteria that are not E. coli or related types can cause UTIs and lead to positive nitrite results, though they are less common.


2. Contamination During Urine Sample Collection

Getting other stuff, like bacteria from the skin or private parts, into the urine sample can also make the nitrite test positive. It's important to collect the sample properly to avoid this:


  • Improper Cleaning: If the private area isn't cleaned properly before collecting urine, outside bacteria can get into the sample, causing a wrong positive result. It's best to clean the area well with antiseptic wipes.

  • Non-Midstream Collection: Taking the first stream of urine instead of the middle part can make the sample dirty. The first stream of urine might have bacteria from the urine tube, while the middle part is cleaner. To avoid this, it's recommended to collect a midstream sample of urine.


3. Dietary Factors

Sometimes, what you eat can also make nitrites show up in urine. Eating lots of foods that are high in nitrates can add to nitrite levels in urine. The body converts these nitrates from food into nitrites, which can end up in urine. Foods that are high in nitrates include:


  • Processed Meats: Processed meats like bacon, sausages, and other processed meats often contain high levels of nitrates, which can turn into nitrites.

  • Leafy Green Vegetables: Vegetables such as spinach, lettuce, and beetroot are naturally high in nitrates.

  • Certain Preservatives: Some food preservatives contain nitrates, which can make nitrite levels in urine go up.


4. Medication and Chemical Interference

Some medicines and chemicals can mess with how urine is made, making nitrite tests show a wrong result. This is less common but still a possible cause. Medicines that can do this include:


  • Antibiotics: Some antibiotics can change the balance of bacteria in the urinary tract, which might cause the nitrite test to be wrong.

  • Other Drugs: Drugs that mess with how your kidneys work or change how urine is made can affect nitrite levels. It's important to tell your doctor about any medicines you're taking when they check your urine.


5. Physiological Factors

Things like how much water you drink can also affect nitrite results. While this is not as common as bacterial causes, it is still important to consider.


  • Hydration Levels: If your urine is concentrated due to dehydration, it can sometimes affect the accuracy of nitrite tests. Proper hydration helps keep your urine in balance and reduces the risk of false-positive results.


Who Gets Nitrite in Urine?

Nitrites in urine can occur in people of all ages and genders, but certain groups of people may be more likely to experience them under certain circumstances. Here's a breakdown of who might often have nitrites in their urine:


Women

Women are generally more prone to urinary tract infections (UTIs) than men. Because of how their urinary tract is built, bacteria can easily get into the bladder and cause infections. So, women might have nitrites in their urine more often than men.


Individuals with a History of UTIs

People who have experienced urinary tract infections in the past may be at a higher risk of getting UTIs again. Having UTIs over and over can lead to more nitrites in the urine.


People with Certain Medical Conditions

People with conditions that make them more likely to have urinary tract problems or weaker immune systems might get UTIs more often, leading to positive nitrite tests in urine. Examples include diabetes, kidney stones, urinary retention, and spinal cord injuries.


Elderly Individuals

As people get older, their immune systems might get weaker, making them more likely to get infections, including UTIs. Things like trouble holding urine, using catheters, or other health problems can also increase the chances of UTIs and nitrites in urine for older people.


Infants and Young Children

Infants and young children may also experience nitrites in urine, often due to diaper-related hygiene issues or urinary tract abnormalities. It's important to maintain good hygiene practices, such as changing diapers frequently and cleaning the area thoroughly, to prevent UTIs and the presence of nitrites in urine in infants and young children.


Sexually Active Individuals

Sexual activity can introduce bacteria into the urinary tract, increasing the risk of UTIs and nitrites in urine, especially in individuals who are sexually active frequently or engage in unprotected intercourse. Practicing safe sex and maintaining good hygiene after intercourse can help reduce the risk of UTIs and nitrites in urine in sexually active individuals.


Pregnant Individuals

Pregnancy can raise the risk of UTIs because of hormonal changes and more pressure on the urinary tract. Finding nitrites in urine during pregnancy needs careful watching and quick treatment to prevent problems.


Individuals with Catheters or Urinary Tract Procedures

People who use urinary catheters or have recently had urinary tract procedures are more likely to get bacteria and UTIs, which can cause positive nitrites in their urine. The use of catheters and the performance of urinary tract procedures can disrupt the normal protective mechanisms of the urinary tract, making individuals more susceptible to infections.


Individuals with Certain Lifestyle Factors

Certain lifestyle factors, such as poor hygiene practices, inadequate hydration, holding urine for extended periods of time, or the use of certain types of contraception, can also contribute to the development of UTIs and nitrites in urine. It's important to maintain good hygiene practices, drink enough water, and empty your bladder regularly to reduce the risk of UTIs and nitrites in urine.


What are the Symptoms of an Urinary Tract Infection?

Urinary tract infections (UTIs) can cause different symptoms, which can be mild or severe. The most common symptoms of a UTI include:


Frequent Urination

People with UTIs may feel like they need to urinate a lot, even when their bladder isn't full. They might only pass small amounts of urine each time. This can be a sign of a UTI.


Pain or Burning Sensation During Urination

A common sign of a UTI is feeling uncomfortable or like something's burning when you urinate. It can feel like a sting or a really bad burn, and it can be mild or really strong.


Cloudy or Foul-Smelling Urine

If you have a UTI, your urine might look cloudy or smell really bad because of bacteria and stuff that makes you inflamed. This change in urine appearance or smell can be a sign that you might have a UTI.


Discomfort or Pressure in the Lower Abdomen

Some people with UTIs may experience discomfort or pressure in the lower abdomen, often around the bladder area. This sensation can range from mild discomfort to more pronounced pain. This discomfort can be a sign that you might have a UTI.


Hematuria (Blood in Urine)

In some cases, UTIs can cause blood in the urine, known as hematuria. The blood in the urine may appear pink, red, or brownish in color. If you see blood in your urine, it's important to seek medical attention.


Fatigue or Weakness

UTIs can sometimes cause symptoms like fatigue, weakness, or a general feeling of being unwell. These symptoms may accompany the more localized urinary symptoms. If you're feeling weak or tired, it's important to see a doctor to determine the cause.


Fever or Chills

In more severe cases, UTIs can lead to fever, chills, and general feelings of illness. Fever is particularly concerning because it may indicate that the infection has spread to the kidneys, which is called pyelonephritis. If you're experiencing fever, chills, or other signs of illness, it's important to see a doctor right away.


Pelvic Pressure or Pain

Women with UTIs may experience pressure or discomfort in the pelvic area, which can sometimes be mistaken for menstrual cramps. If you're experiencing pelvic pressure or discomfort, it's important to consult a doctor to determine the cause and receive appropriate treatment.


Discomfort in the Back or Sides

If a UTI progresses to a kidney infection (pyelonephritis), individuals may experience pain or discomfort in the back or sides, where the kidneys are located. This pain or discomfort is usually a sign that the UTI has become more serious and requires prompt medical attention.


How are Nitrites in Urine Diagnosed?

Nitrites in urine are diagnosed through a simple and commonly used test known as a urine dipstick test. Here's how the diagnosis of nitrites in urine typically happens:


1. Urinalysis

Finding nitrites is often a part of a urine test called urinalysis. This test looks at different things in your urine to check how the urinary tract is doing. During this test, the doctor takes a urine sample and checks it in a lab or with a urine dipstick test.


2. Urine Dipstick Test

The urine dipstick test is a quick diagnostic tool that allows for the detection of nitrites in urine. Nitrite test strips, commonly included in urine dipstick tests, contain chemicals that react with nitrites present in the urine sample.


3. Chemical Reaction

When the nitrite test strip comes into contact with urine containing nitrites, a chemical reaction happens, resulting in a color change on the test strip. The presence of a pink or reddish color on the test strip indicates a positive result for nitrites.


4. Interpretation of Results

Doctors look at how strong the color change is on the nitrite test strip to understand the urine test results. A darker or stronger color means there are more nitrites in the urine, which might mean there are more bacteria in the urinary tract.


5. Confirmation and Further Evaluation

If nitrites are found in the urine, doctors might suggest more tests to make sure there's a UTI or to find out what kind of bacteria is causing it. They might do more urine tests, like urine culture and sensitivity testing, to figure out what bacteria are there and which antibiotics will work best.


Will I Need to Do Anything to Prepare for the Test?

Usually, you don't have to do anything special to prepare before you get a test for nitrites in your urine. But here are some things you can do to make sure the test is done right:


1. Avoid Contamination

To prevent contamination of the urine sample, it's important to clean the genital area thoroughly before providing the sample. For women, this may involve wiping from front to back to avoid transferring bacteria from the anus to the urethra. This will help to make sure that the sample is accurate and reliable.


2. Collect a Midstream Sample

When you collect urine, it's best to start urinating in the toilet and then catch the midstream sample in the clean container they give you. This helps minimize contamination from bacteria that may be present around the opening of the urethra.


3. Follow Instructions Carefully

The healthcare provider who is doing the test will tell you what you need to do. They might tell you not to eat certain foods, not take certain medicines, or to do something else before you give a sample. It's important to follow these instructions carefully so that the test is done right.


4. Inform Your Healthcare Provider

It's important to tell your doctor if you're taking any medicine, vitamins, or herbal medicine before you get a nitrite test. Some of these things can mess up the test and make it look like you have nitrites in your urine when you don't. Your doctor can tell you if you need to stop taking these things before the test. This will help to make sure that the test results are accurate and reliable.


5. Stay Hydrated

It's generally recommended to drink plenty of fluids before providing a urine sample. Staying hydrated helps ensure that you have a good flow of urine and may make it easier to collect a sufficient sample for testing. This will help to make sure that the test results are accurate and reliable.


Why Do Healthcare Providers Test for Nitrites in Urine?

Doctors test for nitrites in urine because it can help them figure out if you have a UTI. UTI is when there are bacteria in your urine, and nitrites are a sign that the bacteria are there. By testing for nitrites, doctors can see if you have a UTI and give you the right medicine to make it better.


1. Identification of Urinary Tract Infections (UTIs)

UTIs happen when bacteria infect parts of the urinary tract like the bladder, urethra, or kidneys. Some bacteria, like E. coli, turn nitrates in urine into nitrites. If doctors find nitrites in your urine, it might mean that you have bacteria that are causing a UTI.


2. Confirmation of Bacterial Infection

If your urine test is positive for nitrites, it can help your doctor figure out if you have a UTI. If you have the symptoms of a UTI and the nitrite test comes back positive, it gives your doctor more information about what's going on. This helps your doctor know for sure that you have a UTI and gives you the right medicine to make it better.


3. Rapid Diagnostic Tool

Nitrite testing is a fast and convenient diagnostic tool that can be performed as part of a routine urinalysis or point-of-care testing. They can do the test at the doctor's office or even at home. This helps doctors figure out if you have a UTI and give you the right medicine right away.


4. Guide for Antibiotic Therapy

If your urine test shows positive nitrites, it can help your doctor know what kind of antibiotic will work best for your UTI. This helps your doctor give you the right medicine so that your UTI gets better faster. It also helps stop bacteria from becoming resistant to antibiotics, which is important for keeping people healthy. This means that patients can get the right treatment more quickly, which can help to reduce the symptoms and prevent further complications.


5. Monitoring Response to Treatment

If you have a UTI and you're taking medicine for it, your doctor might do a nitrite test again to see if the medicine is working. If the nitrite test shows that there are no more nitrites in your urine, it means that the medicine is working and the UTI is getting better. This helps healthcare providers monitor the response to treatment and adjust the treatment plan as needed, which can help to ensure that the infection is fully treated and prevent further complications.


What are the Downsides of Testing for Nitrite-Positive Urine?

Even though the nitrite test can help doctors figure out if you have a UTI, there are some potential downsides to the test. Here are some of them:


1. False Positives and False Negatives

Urine dipstick tests for nitrites may yield false-positive or false-negative results. False-positive results can occur due to factors such as contamination of the urine sample or certain medications that may interfere with the test. False-negative results may occur if the bacteria in the urine do not possess the enzyme necessary to convert nitrates to nitrites.


2. Limited Specificity

The nitrite test can't tell you exactly what kind of bacteria is causing your UTI. It just tells you that there might be bacteria in your urine. To figure out what kind of bacteria is causing the UTI, your doctor might need to do more tests such as urine culture and sensitivity testing. This can help your doctor figure out what medicine will work best to get rid of the UTI.


3. Inability to Differentiate Severity

Nitrite testing does not tell healthcare providers how severe a UTI is. While a positive result means that there are bacteria in the urinary tract, it doesn't provide information about the extent of the infection or the risk of complications. This means that healthcare providers may need additional information to properly diagnose and treat UTIs.


4. Risk of Overdiagnosis or Overtreatment

Relying solely on nitrite tests for diagnosis may lead to overdiagnosis or overtreatment of UTIs, particularly in asymptomatic individuals or those with low bacterial counts. This can lead to you taking antibiotics that you don't need, which can make bacteria stronger and make it harder for antibiotics to work. That's why your doctor might need to do other tests to make sure that you really have a UTI.


5. Inability to Detect Non-Bacterial Causes

Nitrite tests are specific to bacterial infections and may not detect other non-bacterial causes of urinary symptoms, such as viral infections or interstitial cystitis. If your nitrite test is negative but you still have symptoms, your doctor might need to do more tests to figure out what's wrong.


6. Cost and Resources

Nitrite testing requires specialized strips or kits, which may incur additional costs for healthcare facilities and patients. Furthermore, interpreting the results and initiating appropriate follow-up care may require additional time and resources. This means that the cost and the resources needed for nitrite testing can be a burden for healthcare facilities and patients.


Can Nitrites in Urine Cause Complications?

If you have nitrites in your urine, it could mean that you have a UTI. If the UTI isn't treated or managed properly, it can cause complications. Here are some of the complications that could happen if you have nitrites in your urine:


Kidney Infections (Pyelonephritis)

If a UTI, indicated by the presence of nitrites in urine, is left untreated or inadequately treated, the infection can ascend from the lower urinary tract to the kidneys. Pyelonephritis, or kidney infection, can lead to more severe symptoms such as fever, chills, back pain, nausea, and vomiting. If it's not treated, it can cause your kidneys to get damaged or even cause a life-threatening infection called sepsis.


Sepsis

If you don't treat a UTI, it can turn into sepsis, which is a very serious and life-threatening condition. Sepsis can cause your organs to stop working right and can even cause you to die if you don't get treatment right away in a hospital. That's why it's important to get the right treatment for UTIs as soon as possible to prevent sepsis from happening.


Recurrent UTIs

If you keep getting UTIs, especially if left untreated or inadequately treated, it can lead to more infections. This can make you feel sick and tired all the time, and you might need to go to the doctor a lot. You might also need to take antibiotics for a long time or do things to prevent the UTIs from coming back. This can be very hard and expensive.


Chronic Kidney Disease

If you keep getting UTIs or if you have UTIs that are really bad, it can hurt your kidneys. This can lead to a condition called chronic kidney disease, which means that your kidneys don't work as well. Chronic kidney disease can cause high blood pressure, fluid build-up, problems with your body's balance of salts and minerals, and heart problems. This can be serious and may require dialysis or a kidney transplant.


Systemic Infections

If you don't treat a UTI, it can lead to a really bad infection in your blood. This is called septicemia or urosepsis and can cause your whole body to get really sick and your organs to stop working right. This can be life-threatening. Nitrites in your urine can be a sign that you have a UTI that can lead to these infections, so it's important to treat UTIs as soon as possible.


Complications in Specific Populations

Some people, like pregnant women and people with weak immune systems, are more at risk of getting sick from UTIs and having nitrites in their urine. If pregnant women don't treat UTIs, it can make them go into labor early or have problems during delivery. People with conditions like diabetes or HIV might get really bad UTIs and have more problems. This means that it's important for these populations to get the right treatment for UTIs as soon as possible to prevent more serious complications.


How Are Nitrites in Urine Treated?

Nitrites in urine are typically treated by addressing the underlying cause, which is often a urinary tract infection (UTI) caused by bacteria. Here's how nitrites in urine are commonly treated:


1. Antibiotic Therapy

If you have nitrites in your urine because of a UTI, your doctor will give you antibiotics to kill the bacteria causing the infection. Your doctor will choose the antibiotics based on the type of bacteria that are in your urine and what kind of medicine will work best for that bacteria. Some common antibiotics for UTIs are trimethoprim-sulfamethoxazole, ciprofloxacin, nitrofurantoin, and amoxicillin. It's important to finish all of the antibiotics that your doctor gives you, even if you start feeling better before you finish all of the pills. This ensures that the bacteria is completely eliminated and prevents the infection from returning.


2. Antibiotic Sensitivity Testing

If your doctor doesn't know what kind of bacteria is causing your UTI or if the first antibiotics don't work, they might do a test called urine culture and sensitivity testing. This test helps your doctor find out what kind of bacteria is causing the UTI and figure out which antibiotics will work best to get rid of it.


3. Symptomatic Relief

In addition to antibiotics, your doctor might give you medicine to help with the symptoms of the UTI, like pain or a fever. These medicines might include over-the-counter pain relievers like ibuprofen or acetaminophen to help with the pain and fever. These medications can help to manage symptoms until the antibiotics start to work.


4. Hydration

Drinking lots of water can help get rid of the bacteria in your urine and make your urine less conducive to bacterial growth. Drinking lots of water is important when you have a UTI because it helps your body fight the infection.


5. Urinary Alkalinization

In some cases, your doctor may recommend urinary alkalinization, which involves eating certain foods or taking medicine to make your urine less acidic. Alkalinizing agents can help reduce the acidity of the urine, creating an environment less favorable for bacterial growth. This can help reduce the symptoms of a UTI and help the body fight off the infection.


6. Follow-Up Care

It's important to finish all the antibiotics that your doctor gives you, even if you start feeling better before you finish all the medicines. If you don't finish all the antibiotics, the bacteria might become resistant to the antibiotics and you might get the UTI again.


Can You Prevent Nitrite-Positive Urine?

While it may not be possible to completely prevent nitrite-positive urine,  there are things you can do to lower the chances of getting a UTI and detecting nitrites in your urine:


1. Practice Good Hygiene

Keeping your private parts clean can help prevent bacteria from getting into your urinary tract. Always wipe from the front to the back when you go to the bathroom to prevent bacteria from entering the urethra.


2. Stay Hydrated

Drink enough water every day to help flush out bacteria and make urine less concentrated. Try to drink at least eight glasses of water a day, or more if you're physically active or live in a hot place. Drinking lots of water helps to keep bacteria from building up in the urinary tract and causing an infection.


3. Urinate Regularly

Going to the bathroom when you need to can help prevent bacteria from building up in your urinary tract. Don't hold your urine for a long time and make sure to urinate as much as you can each time you go to the bathroom. Going to the bathroom regularly helps to keep bacteria from building up in the urinary tract and causing an infection.


4. Avoid Irritants

Don't use harsh soaps, perfumes, or feminine sprays that can irritate the urethra and increase the chance of UTIs. You should also limit things like caffeine, alcohol, and spicy food because they can irritate your bladder and cause UTIs. These irritants can make it more likely for bacteria to grow in the urinary tract and cause an infection.


5. Practice Safe Sex

Using condoms during sex can help protect you from sexually transmitted infections and bacteria that can cause UTIs. Safe sex practices can help to keep bacteria from being spread during sexual activity and reduce the risk of UTIs.


6. Empty Bladder After Intercourse

Urinating after sex can help flush bacteria out of your urinary tract and lower the chances of you getting a UTI. This helps to prevent bacteria from building up in the urinary tract and causing an infection.


When to See a Doctor

Knowing when to see a doctor is important for keeping your urinary tract healthy and dealing with problems quickly. Here are some times when you should see a doctor for help:


  • Persistent Symptoms: If you have persistent symptoms such as pain or burning during urination, frequent urination, urgency to urinate, or cloudy or foul-smelling urine, and these symptoms don't go away, you should see a doctor. These could be signs of a UTI or another problem that needs a doctor to check out.

  • Presence of Blood in Urine: If you see blood in your urine, whether you can see it with your eyes or if it's too small to see and needs to be looked at with a microscope, you should see a doctor right away. Blood in your urine can mean that you have a UTI, kidney stones, or other problems in your urinary tract that need to be checked out by a doctor.

  • Fever or Chills: If you develop a fever along with urinary symptoms such as pain or discomfort, it may indicate a more severe infection, such as a kidney infection. Fever and chills are signs that the infection may be spreading and require prompt medical attention. Fever and chills can be serious symptoms and they should not be ignored. If you develop these symptoms along with urinary symptoms, it's important to see a doctor as soon as possible.

  • Recurrent UTIs: If you keep getting UTIs or you have symptoms like pain or discomfort when you urinate a lot, you should see a doctor to talk about ways to prevent UTIs and to find out if there's something else causing your UTIs. Recurrent UTIs can lead to more problems and might need more tests or treatments to keep them from happening again.

  • New or Severe Symptoms: Any new or severe urinary symptoms, such as sudden onset of intense pain, difficulty urinating, or urinary retention, warrant immediate medical attention to rule out serious conditions like kidney infections or urinary obstruction. Any new or severe symptoms should be taken seriously and you should see a doctor immediately to find out what the cause is and how to treat it.

  • Special Populations: Some people, like pregnant women, people with diabetes, older adults, and people with weak immune systems, are more likely to have problems with their urinary tract. If you're one of these people and you have symptoms like pain or discomfort when you urinate, you should see a doctor right away to make sure there isn't anything serious going on.


Take charge of your health today! Center One Medical can help you understand the nitrite in urine and give you personalized solutions to improve your health. Contact us and book an appointment now with our team of medical professionals. At Center One Medical, your health is our top priority. We care about you and want to help you with any urinary health issues you might have. Trust Center One Medical for excellent care that focuses on you.


Conclusion

In conclusion, having nitrite in your urine can tell you a lot about your urinary health. If you have high levels of nitrite in your urine, it can be a sign of a urinary tract infection (UTI), and you need to see a doctor right away. Though testing can be hard, it's important for catching problems early. To lower your chances of getting UTIs and nitrite in your urine, it's important to drink lots of water and eat healthy foods. If you have UTI symptoms, see a doctor right away to ensure effective treatment and maintain overall well-being.



FAQs


1. What are the common symptoms of a urinary tract infection (UTI)?

  • If you have a UTI, you might have symptoms like having to urinate a lot, pain or burning when you urinate, and urine that's cloudy or smelly. Knowing these symptoms can help you catch UTIs early.

2. Can dietary changes alone reduce nitrite levels in urine?

  • Changing your diet can help to reduce nitrite levels in urine, but you should talk to a doctor about the best way to manage nitrite levels. Dietary changes can be part of the solution, but it's important to work with a doctor for a full plan.

3. How often should one undergo nitrite testing in urine?

  • How often you get tested for nitrite in your urine depends on your health. If you keep getting UTIs or have chronic conditions, your doctor might recommend that you get tested more often. Talk to your doctor to find out how often you should get tested.

4. Are home urine test strips reliable for nitrite detection?

  • Home test strips for nitrite in your urine can be convenient, but they might not be as accurate as lab tests. To get the most accurate results, you should go to a lab to get tested. Knowing the limitations of home testing will help you get reliable results.

5. What role do medications play in influencing nitrite levels?

  • Some medications can affect the amount of nitrite in your urine. It's important to tell your doctor about all the medications you're taking so that they can interpret the results correctly. Talking openly with your doctor will make sure that the test results are accurate.

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