Symptoms but tests are negative

[spicer]

Is there a strain of bacteria, maybe something new, that could be causing the symptoms of a bladder infection in women that do not show up in the urine sample?  I have been through this so many times, and I read farther down this forum that two other girls have this same problem, so I can't help but think that something is going on.  My symptoms are as follows:  I will begin to feel as though I am getting a bladder infection, I will go to my doctor who will test my urine for bacteria but it comes out negative.  He will prescribe antibiotics for me 'just in case', and when I take them, I start to feel better and the symptoms go away.  I will usually be fine for a couple of months and then it starts again, same symptoms, same negative test.  But when I take antibiotics, whatever 'it' is clears up and goes away.  There was only one time when I didn't take them just to see if it would go away on it's own, and it felt like whatever it was, was doing a slow 'simmer' for lack of a better word, and by the end of the month, I was in so much pain I could barely stand.  After I started the antibiotics, it cleared up and went away.  What in the world is going on??  If there's no infection, why would antibiotics help then?  I've been tested for other things, including IC, and everyone says I am fine.  If I am fine, then what is this?  I can't help thinking there has got to be some kind of infection somewhere if I'm feeling the way I am.  My questions are - What kind of infection could I (and the others below) possibly have that doesn't show up in the urine?  And why would I keep getting this, whatever 'this' is?  I am 50 years old and have already been through menopause, in fact it was during this time that all this started.  I would normally think that maybe something else is going on that makes me feel like this and simply comes and goes.  But if I don't take antibiotics, it doesn't 'go', it just keeps getting worse.  

Do you have any idea at all what is going on?  Or have you ever heard of such a thing?  I would appreciate any insight you could give, as nobody else, not even my own doctor, seems to have an answer.  Thank-you so so much.

[Kevin Pho, MD]

Hello - thanks for asking your question.

Recurrent urinary tract infections (UTIs) are common in women. However, there is no evidence that recurrent UTI leads to health problems such as hypertension or renal disease, in the absence of anatomic or functional abnormalities of the urinary tract.

A number of factors also appear to increase the risk of recurrent UTIs.

Biologic or genetic factors — Women with recurrent UTI have been shown to have an increased susceptibility to vaginal colonization with uropathogens, even during asymptomatic periods, compared with women without a history of recurrences.

Behavioral risk factors — Sexual intercourse, diaphragm-spermicide use and a history of recurrent UTI have been shown to be strong and independent risk factors for UTI.

Pelvic anatomy — Pelvic anatomy may predispose to recurrent UTI in some women, especially those who do not have exogenous risk factors for UTI.

Postmenopausal women - In a study of postmenopausal women, factors such as urinary incontinence, presence of a cystocele, and postvoiding residual urine (all factors more common in postmenopause) is associated with recurrent UTIs.

A number of strategies have been used in an attempt to prevent recurrent UTIs.

Contraception — Women with recurrent UTI who are sexually active or who use spermicides (particularly in conjunction with diaphragms), should be counseled about the possible association between their infections and sexual intercourse and use of spermicides.

Post-coital voiding and liberal fluid intake — It is reasonable to suggest to women that early post-coital voiding and more liberal fluid intake to increase the frequency of micturition might be helpful.

Cranberry juice — Cranberry juice has been touted as an effective home remedy for preventing UTI for decades.

Antimicrobial prophylaxis — Antimicrobial prophylaxis has been demonstrated to be highly effective in reducing the risk of recurrent UTI in women.  Prophylaxis has been advocated for women who experience two or more symptomatic UTIs within six months or three or more over 12 months.

Prophylaxis in postmenopausal women — In one study of 93 postmenopausal women with a history of recurrent UTI, topically applied intravaginal estriol cream for eight months significantly reduced the incidence of UTI compared to placebo. Patients treated with estrogen cream had an increase in the prevalence of lactobacilli and decrease in E. coli vaginal colonization.

Urology consultation - Further evaluation of the urinary tract is recommended if suspicion arises with any of the recurrences about complicating factors such as structural or functional abnormalities of the genitourinary tract.

I strongly suggest continue followup with your personal physician.

I stress that this answer is not intended as and does not substitute for medical advice - please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

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