Urogynecology Expert Forum
UTI-
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Questions in the Urogynecology forum are answered by Bruce Crawford, MD, J. Kyle Mathews, MD, and other medical professionals and experts. Topics covered include overactive bladders, bladder pain, fallen/drooping bladder, bowel urgency, bowel prolapse, cystitis, incontinence, pain with intercourse, rectal prolapse, surgery, urinary urgency, and uterine prolapse.

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UTI-

I had a UTI for the first time 12/5/07.  I took Cipro for 5 days.  Went back to the dr and took another test to make sure it cleard up.  I took a test in the dr's office and it showed slight bacteria. So she gave me another 5 days of Cipro. Went back on 12/17 for a test in the lab showed negative and everything cleared up. The bacterial that I had was 50,000 urogential flora.  

got up this a.m. and felt some pain in my lower back (above the butt area), I've had this pain before getting these infections but wanted to make sure the infections didn't come back and took a home UTI test and it showed negative nitrate but a little WBC.  So I went back today. Dr took a urine test in her office, said it was a little bacteria, gave me 10 day cipro,  but sent the urine  to the lab. The lab results came back all negative.  So now, I'm assuming they won't do a culture, because it's negative. I have to wait until Wed to hear back from my dr so I will continue the medicine.   And my dr said urogential flora is my own bacteria? how can I prevent these from coming back??  
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To diagnose a UTI, you need a positive urine culture. This takes about 3-5 days to grow. You can't get a culture result from a rapid office test. The office test is looking for evidence of infection, like white cells, nitrites ( a bacterial by product). and leukocyte esterase (a by product of the white cells which come to fight the bacteria). If you have an office dip with positive Nitrites, and Positive leukocyte esterase, then it is fair to infer a UTI, and to treat with antibiotics. If the symptoms persist after a few days on antibiotics, then it makes sense to get a urine culture to see what bugs, if any are actually growing out. THe wrinkle is, that if you collect urine from a "clean catch"  (i.e., you urinate into a cup after cleaning off the labia), you can still collect bacteria from the vagina, (which can grow in culture in the absence of bad bugs like E. Coli); These can be lactobaccilli (good bacteria from the vagina), or Gardenerella (also from the vagina, and kept in check by the lactobacilli), and other vaginal bugs. In the case where vaginal bugs grow out in the culture, the culture report usually says (50,000 mixed flora, considered normal vaginal flora). The mixed flora cultures do not need to be treated. In fact, you do not want to get rid of these. It sounds like you have a negative urine culture.

If you are having UTI symptoms in the setting of a negative urine culture, you may need an evaluation for overactive bladder, which is readily treated with anticholinergics (e.g., detrol or vesicare) or physical therapy. Antibiotics do not help if your urine culture is negative.

Dr. Hoyte

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