UTI since March - Will it ever go away?

[Dianne0720]

First let me tell you how I believe I got his UTI.  I had sex and I had germs on my hands after touching my cat.  I had intense urethra pain almost immediately after orgasm.  I went to Urgent Care and cuture grew E coli and I took Macrobid which did not work and then Cipro.  A short time later, pain returned and I went to my PCP and culture grew Strep for which I took Keflex.   Still having pain, I had another culture done.  This time it grew enterococcus.  My doctor game me Ampicillin.  I finished the course and went back for culture and it still came back positive for enterococcus.  She then put me on a higher dose of Ampicilling (850mg) and said I should see a Urologist or Urogyn.  I went to Urologist and have had a bladder/kidney ultrasound which was negative, postvoid residual scan results = scant, and I am scheduled for a cystoscopy next week.  I have taken Cipro 500, Levofloxacin 2 different times and I still have this enterococcus bacteria.  It will not go away.  I believe that this infection all goes back to the sex I had in March with dirty hands.  I haven't done anything since that time to reinfect myself.  What are you thoughts on this?  Is it possible that this infection will never go away?  I am in pain everyday now for 5 months.  Thanks so much for any insight that you can offer.

[ppinky]

Hi Iam getting exactly same thing from last 5 months. can you please tell me what happened in your case finally. though i know its been a long time.

[Peruvianclaudia1989]

Hi me too , pls email me ***@**** its been horrible!

[Dianne0720]

My culture is still positive with enterococcus.  I haven't seen the report yet but my doctor says it is now resistant to Levaquin.  She is putting me on 875 mg. of Ampicillin for 20 days.  I just want to see what your thoughts were about that.  

[Dr Smitha Mathews]

Hi Dianne,

The responses from medical practitioners on this forum are free of charge.

The idea of the cranberry juice is to get in some fluid as well as the essential vitamin C :-) but you can continue with the tablets alone if you find that more convenient.

Personally, I would not advice any invasive investigations at this point until the culture sensitivity report comes in and the UTI is treated effectively with the antibiotics. This is just so as to prevent any further injury to the inflamed mucosa of the urethra or the bladder while there is a possibly resistant infection in the area.

Though women have a shorter urethra than men and while this makes it easier to put in a catheter or scope to visualize the bladder, it still does not rule out the possibility of injuring the urethral mucosa and the resultant complications in the form of strictures.

I think the VUDS would be a good idea but again only after this bout of infection is treated.

Do keep us posted on any doubts and progress.
regards,

[Dianne0720]

You have been more helpful than my Primary Care or the Urologist I have been seeing for the past 2 months.  My PCP tries very hard and the Urologist I have been going to is a nightmare.  It was 16 days before I found out my first urine culture was positive for Enterococcus.  They forgot to call me.  And the 2nd culture 2 weeks llater didn't get sent to LabCorp for C&S.  He said "I know I ordered it but I guess we forgot to sent it out."  He wants to do a cystoscopy which is sheduled for next week.  Do you think I need a cystoscopy?  Or a VUDS maybe?  

I have the cranberry tablets but I will get some juice and fish oil capsules also.  I can't tell you how much I appreciate this!  Also, my PCP did check me for diabetes and thank goodness....it was negative.  Thanks a million!

[Dr Smitha Mathews]

Hi,

Good to hear about the culture.

Gentamicin would have to be administered either IV or IM for infections as it is not absorbed sufficiently on oral administration. IM injections may be more painful than IV and may not be a great idea if you are on the twice daily dosing regimen.

The drug can be administered through an IV cannula (a small plastic tube left in a vein for the duration of injections or for 3 days) as you will need to feel the pain of the needle only once. Maintain hygiene with the cannula as it can get infected if uncared for. Ensure you do not wet the area the  cannula has been inserted in (usually the dorsum of a hand) and do ask  the health care professional inserting the cannula to pick a spot away from a joint (there are frequent movements at joints and this can cause the cannula to dislodge or bend). In view of the toxicity of aminoglycosides, it would be better not to opt for the once-daily higher dose, unless that is required.

Symptoms of side effects include ringing in the ears, lightheadedness, nausea, loss of equilibrium, etc.

Do increase your intake of cranberry and citrus juices as they help to acidify the urine and aid in clearing the bacteria. Supplements containing vitamin A and omega-3 fatty acids (Fish liver oil)  will also improve immunity and mucosal resistance to infections.

regards

[Dianne0720]

Thanks so much.  This is great information.  I just had another culture sent off today and will wait to check sensitivites.  If my doctor agrees to Gentamicin, would IM be preferred over PO?  

[Dr Smitha Mathews]

Hi,

A UTI predisposes to developing further infections of the urinary tract. This includes infection of the kidney, bladder, or the urethra. Additionally, antibiotic treatment can eliminate the natural flora in the body and predispose to developing further infections.
Other underlying conditions, such as diabetes, which lower immunity can also contribute to the development of infections.
The initial infection could have been due to sex, but the following episodes may be sequelae to the first infection and the UTI.

Enterococcus has several resistant strains wherein the bacteria is resistant to a number of antibiotics. These include the antibiotics you have taken already, especially the ampicillin which would have needed to be combined with other agents like clavulinic acid to be effective. Similarly, the strain of enterococcus appears to be resistant to quinolones (ciprofloxacin, levofloxacin, etc.) as well.

If you have the culture report, check which antibiotic inhibits the bacteria as mentioned in the report. Check which antibiotic the bacteria is sensitive to and have that antibiotic prescribed after discussion with your doctor.
Enterococcus is usually susceptible to treatment with gentamicin or other amino glycosides. In strains resistant to these 2 drugs, treatment with quinpristin may be warranted.