Sharp, shooting pains in urethra and vagina

[UrethraFranklin]

I was recently diagnosed with "beta hemolytic streptococcus" from a vaginal swab and was placed on Erythromycin. Originally, a UTI was suspected, but the urine sample was clean. My symptoms are sharp, shooting pains in the vagina and urethra that happen when I'm not urinating (I could be just waking up, lying in bed still, or at my desk at work). I also have pressure in the lower pelvic area between the ovaries, and a lot of small bumps covering the folds of skin that shield the urethra, as well as frequent urination. From the antibiotic, I suspect I also have a yeast infection. My questions are:

1. Which other STDs should I be tested for?
2. What else could these symptoms be, if not an STD?
3. I've been on erythromycin for 5 days (out of ten total) and the pains are still there. They are somewhat more muted, but I'm still I'm very disappointed. How long does it take to clear up, if this is what it is?
4. I've recently contracted these symptoms after being with a new partner. What should he be tested for?
5. I have a second opinion with an OBGYN scheduled for next Tuesday, since the first doctor who diagnosed me treated me with such disdain and couldn't really explain much about what it is. I finish the erythromycin on Monday. Will the antibiotic skew any smears or cultures? I'm planning on asking to be tested for everything that I can. I'm pretty scared.

Thank you for your help. I'm feeling pretty crappy about this.

[H. Hunter Handsfield, M.D.]

Great name!  I'll try to show a lot of respect....

Group B beta-hemolytic strep (GBS) is present fairly commonly in the vagina, not primarily sexually transmitted (although sometimes shared with male partners), and generally causes no symptoms.  It is related to but different than group A strep, the cause of strep throat, skin infections, and some pretty nasty other things.

The main problem with GBS is transmission to babies during delivery; it can cause horrible infections in newborns, sometimes fatal.  However, in adult women it usually is just colonizing the vagina, without ill effect.  It is likely that your symptoms are due to something else, but GBS was picked up by coincidence.  Most experts would not have even tested you for GBS, and we don't do it in my STD clinic.  All that said, GBS may sometimes cause symptomatic vaginal infections; this area is a bit controversial.

As to other STDs, you say nothing about how risky your new partnership might be, e.g. whether he had other partners recently.  But your symptoms and the new relationship both raise concerns about chlamydia, gonorrhea, trichomonas, and bacterial vaginosis or, in a worst-case scenario, pelvic inflammatory disease--with or without the yeast infection you suspect.  None of those is best treated with erythromycin; it usually would work against chlamydia, sometimes against gonorrhea, variable against PID (depending on the exact cause of the PID), and not at all against trich or BV.  You should definitely be tested for all those--but you are right that negative results for gonorrhea and chlamydia won't mean much, because of the erythromycin.  (Your doctor should not have started the antibiotic without first testing for them. Maybe he did; you should check if not sure.)  Your partner should be examined, and tested for gonorrhea and chlamydia.

Don't be too worried about serious outcomes.  Although erythromycin isn't ideal, it probably is keeping the lid on things until you get on something better, depending on your new doctor's judgment and perhaps additional testing.

Good luck--  HHH, MD

[UrethraFranklin]

Thank you, Dr. HHH.

I just spoke with the gynecologist and inquired as to what was tested. Before beginning the erythromycin, I was tested for chlamydia and gonorrhea (both which were negative), and also had a pap smear (which was negative).

My urethral symptoms began last month and culminated into a VERY painful night in the ER. Upon suspect of a urinary tract infection (the urine was not cultured; it was really cloudy, though). I was put on Levaquin for one week, and although it greatly reduced the pain, it did not eradicate it, which was why I suspected an STD and made an appointment with a gynecologist.

I had stopped the Levaquin for seven days prior to seeing the gynecologist for the pap smear and STD cultures. Do you suppose the Levaquin could have resulted in a false-negative for either chlamydia or gonorrhea?

Also, because of the erythromycin I'm taking now, would a test for BV and trich be most likely result in a false negative at my appointment next Tuesday? (I finish the erythromycin next Monday).

What is the best antibiotic to take for chlamydia, gonorrhea, BV, and trich?

And, one last question: Since you mentioned the beta hemolytic strep is not the same as sore throat strep, can I still kiss my boyfriend without fear of infecting myself again?

Thank you for all of your help. I'm very new to all of this STD stuff. And for now on, long live latex ;):)

[H. Hunter Handsfield, M.D.]

Ah--the earlier symptoms and treatment makes a difference.  Levofloxacin (Levaquin) is excellent treatment against both gonorrhea and chlamydia--not the first choice, but that's only because it is much more expensive than single-dose treatment with the recommended drugs, cefixime, azithromycin, and a couple others.  Yes, within a few days that treatment would make any test for those infections negative.  Too bad the ER doc didn't test you for gonorrhea and chlamydia; your symptoms certainly were consistent with those possbilities, especially since your urine culture apparently was negative.  The usual treatment for either BV or trich is metronidazole (Flagyl), but with your more detailed history I doubt you have either of those, at least not as the main problem.

If your boyfriend hasn't been tested for gonorrhea and chlamydia, I recommend he do so--certainly before you resume having sex with him (and if you have, even more important that he be checked).  But don't worry about kissing and group B strep, either from the standpoint of his health or yours.

Good luck again--  HHH, MD

[UrethraFranklin]

Wow, okay. This may be all coming together.

While on treatment for my initial pseudo-UTI with Levaquin, I continued having sex with my boyfriend; therefore, I probably reinfected myself over and over.

Here's my plan: Finish the erythromycin through Monday until the bottle is empty, as prescribed. Then wait until it's out of my system before going for a re-test for chlamydia and gonorrhea, and an initial one for trich and BV.

One last question (and thanks so much for your help, by the way! This board is, by far, the most informative and comprehensive source - thanks!): how long does erythromycin stay in the body enough to interfere with a chlamydia and gonorrhea test? While I shudder to think of the pain involved in the urination process (besides pressure in the pelvis and frequency, the sharp, shooting pains and sharp pain while urinating is horrible), I'd like to get a definitive answer and get this thing out of my body so I can just move on and get going. It's been about a month and a half now.

Thanks again!

[H. Hunter Handsfield, M.D.]

You'd better figure on never knowing for sure.  The antibiotics don't just interfere with the test, they make the test negative by eradicating the infection.  Even if you were reinfected promply with chlamydia (or gonorrhea) from your partner, the erythromycin probably will take care of it.  So it doesn't matter when you are tested--if you now are avoiding sex until your partner is diagnosed and/or treated (which you definitely should do), your test results will be negative.  Of course, you would also have a clear answer if your partner tests positive.  But if he is negative, it won't rule anything out--spontaneous cure typically occurs in men within a few weeks, so he could have had gonorrhea or chlamydia, never known it, and have the tests negative.

At this point, make sure your partner is examined, tested, and perhaps treated.

And one final possibility--which I don't intend to alarm you at this point--is herpes. That STD can present with pretty painful lower genital symptoms, but without recognized open sores.  It's the severity of your urinary symptoms and pelvic "pressure" that grabbed my attention on this.  If your boyfriend tests positive for gonorrhea or chlamydia, you can assume that's the answer.  If not, it might not be a bad idea for you both to be tested for HSV infection, or at least be on the alert for mild recurrent symptoms and be tested then.  See numerous other posts about the right kind of herpes blood test.

Thanks for the kind words about the forum.  Best wishes--  HHH, MD

[UrethraFranklin]

:(

Consider me alarmed. My first sore just surfaced on my vaginal area. It's painful and a series of small "clusters" (although painless), appear just near the opening of my urethra.

I am disappointed, to say the very least.

Before I begin finger pointing, what is the possibility I contracted this from my present boyfriend? We began sleeping together New Years' Eve, and my "urinary" symptoms began about a month later. Is it possible this could have been laying dormant in me from a year ago from my last partner?

Also, these shooting pains in my vagina -- will they go away, or is this something I have to live with? I find that drinking a lot of fluid seems to help, especially cranberry juice.

Thank you for your help.

[prchute]

I am certainly no doctor but I've been dealing with a Beta Hemolytic Strep UTI for over 1 year. I had sharp pains in my uretha and bladder. My uretha pains are from dryness and have been prescribed Estrace Cream. You don't say your age so I don't know if this applies to you or not but thought I'd put the info out there to be considered. Another thing to be sure to do is - after using the bathroom, wipe from front to back. This is VERY IMPORTANT. I finally realized that I was probably reinfecting myself because I was wiping from back to front as most women do. The Estrace Cream has helped a lot with the burning sensation; however, I was just cultured again and after taking more than 30 days worth of 250 mg Augmentin 3/day, I still have 10,000 - 25,000 colonies.  I am at a loss to understand why the Beta Strep won't die. I am not having any sex, wipe from front to back, take great care in cleanliness and still have colonies. Hope my story can add another perspective to what you're going through. Good health to you.

[UrethraFranklin]

Thank you, PRchute. I will implement your suggestions immediately, as I have that certain bad wiping habit as well ;) Interesting thing, that beta hemolytic strep; I'll get retested in a month or so to see how my colonies are as well. Should I come across any pertinent information, I will certainly share. Good health to you. - UrethraFranklin

[dan burns]