This question is testing your knowledge on acute cystitis caused by Chlamydiae.

Chlamydial cell wall lacks classic peptidoglycan (due to reduced muramic acid), rendering β-lactam antibiotics ineffective.

Labs will demonstrate a (positive) leukocyte esterase. (positive) nitrites (indicates presence of Enterobacteriaceae). Sterile pyuria (pyuria with negative urine cultures) could suggest urethritis by Neisseria gonorrhoeae or Chlamydia trachomatis.