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    What causes persistent vaginal irritation despite taking Macrobid and Keflex?

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Posted on Mon, 7 Dec 2015 in General Health
Question: I have talked to you before and you were very reassuring. I am going to send you a copy of the question I was asking someone else. He didn't really answer it.
I had a uti in XXXXXXX Keflex didn't eradicate it. Took macrobid and urine was clear on dipstick for a couple of months even though minor urethra and vaginal irritation continued. Started using vaginal estriol cream (I am 64 year old, post menopausal). Symptoms increased a bit, still not horrible, in September. Had white cells on dip. Took macrobid 2 weeks. Again clear urine dip and symptoms reduced but not totally gone. Now it's back again. Cultured it and ecoli is present. Symptoms still relatively minor... Urethra and vaginal irritation is main symptom and that is off and on. This time the Dr put me on one week macrobid with change to ampicillin afterthat... Low dose, 250 mg 3 times a day dfor 6 weeks. I hate to take antibiotics and just wondering of that sounds Okay. I don't understand where this is coming from and I worry alot and am pretty scared. I'm not sexually active either. I use cranberry tabs and d-mannose and other anti inflammatory supplements and drink lots of water. Sometimes I don't feel anything. My doctor thinks there may be an access in the bladder, which is why he is treating long term. But I don't see anything on the internet to even suggest that possibility. Also, my sister is deathly allergic to penicillin so I have always refused it. Dr says that is not a valid reason and it is the safest. I'm also worrying about cancer. But Dr said my urine showed normal amts of epithelial cells and rbc so he says that shouldn't be a concern. Please help... I'm really nervous.... Can't sleep

That's the question.... I hope you can help.
doctor
Answered by Dr. Matthew J. Mangat 37 minutes later
Brief Answer:
You're losing sleep without reason.

Detailed Answer:
Hi XXXXXXX
How are you. Never thought you would have another U.T.I , actually.
Hope your're not drinking more than 12 glasses fluids daily.
Hope you remember to exercise daily. It'll help relieve your symptoms a lot.
Or else, meditate for 30 minutes twice daily.
If you exercise and meditate, the benefits are compounded.
For vaginal irritation, you should see a gynecologist and get a check-up done.
Take her advice, for vaginal estriol cream application.
Your urine culture may be sent for my perusal.
Stop or avoid (in case, you've not started), amplicillin.
Don't take any antibiotics. You seem to be loaded with Macrobid.
Avoid anti-inflammatory tablets. They have a potential harmful effect on kidneys. You can continue with Cranpac with D-Mannose tablets.
Cancer doesn't present with your symptoms. You can take it off your mind.
Don't think of bladder abscess. Your symptoms are not like that either.
Don't lose sleep unnecessarily, XXXXXXX
I'll reply after seeing your latest urine culture report.
Wish you well and sound,restful sleep.
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Matthew J. Mangat 15 minutes later
Why wouldn't I take the macrobid? I have another infection, or it never went away. I don't have the report. But there was 100,000,ecoli, mod wbc, cloudy urine. He prescribed the course I sent to you because it came back. Urine was clear, by dipstick, of wbcs for 4 weeks, then symptoms worsened and there were wbcs again and the culture was as I said. I don't take anti-inflammatory meds. I meant supplements XXXXXXX turmeric, resveratrol, fish oil. My symptoms are not bad but more irritating. Mainly centered around urethra and vaginal area. Bladder doesn't hurt. And the other discomfort is relatively mild but gets a bit worse when the wbcs are back.
doctor
Answered by Dr. Matthew J. Mangat 5 minutes later
Brief Answer:
antibiotics as indicated only. Gynec check-up is must.

Detailed Answer:
Hi XXXXXXX again.
The culture report you mention is significant U.T.I.(E.coli).
In that case, you should take the most sensitive antibiotic, according to report.
But for recurrent UTI, you would need to have a cystoscopy test, after an ultrasound scan of abdomen.
Also your blood tests like CBC,creatinine, sugar and LFT is needed.
You must have a gynecologist check-up, before the cystoscopy is done.
Hope your worries have decreased.
Have you started a meditation schedule.
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Matthew J. Mangat 0 minute later
I did go to the gynecologist who said I was dry and said to use the estriol cream in small arts. That was a couple of months ago, after the first infection. Don't I need to get rid of this ecoli? Does it mean I have a bad immune system? I don't really get sick alot normally. And I haven't had a blood test for diabetes for 3 years but it was perfect and there's zero glucose in my urine now. I worry about all this!
No, now I'm more scared since you're talking about all those needed tests. What are all those for? I just went to the gynecologist. Nothing was wrong but dryness. Because you're telling me about all those tests, now I fear you're thinking something bad.... I'm suppose to go out for town for Thanksgiving and I'm afraid to go.... My doctor wants to do the longer course of antibiotics I described to try and rid the infection and keep it away.
If there's no protein or glucose in my urine, isn't that a good sign?
doctor
Answered by Dr. Matthew J. Mangat 40 minutes later
Brief Answer:
Checking HbA1C is good enough.

Detailed Answer:
Hi XXXXXXX
If you've already sen a gynecologist,she's the best person to advise you about the vaginal irritation.
Diabetes is best checked by a single test called HbA1C.
If you've not checked blood sugar in 3 years, it's good to know ,you're healthy.
Absence of urine sugar, isn't enough.
Absence of urine protein and sugar are certainly good signs.
If you're continuing with Macrobid, then you need it only as a night time single tablet for another 2 weeks.
Continue with the urethral estriol cream.It does help.
Wish you well.
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Matthew J. Mangat 23 minutes later
So I shouldn't do it like he said... twice a day for a week and then low dose ampicillin? Macrobid alone obviously hasn't worked. I know about the a1c. I believe it was about 5 the last time. My doctor said if this was from diabetes, there should be sugar in the urine.... Because the sugar in the urine would be causing the symptoms etc. Also, why did you mention those other tests? Is any of this indicative of some systemic problem? That's what you've got me worried about now. Dr said there's nothing in the urine or my symptoms to suggest kidney problems. Why the CBC, Creatinine and LFT other than routine? I'm thinking of myself as unhealthy now. And what about all those other tests you mentioned? Are you thinking something bad? I don't have ins, btw.
Did you see this one? I appreciate your diligence. So I guess I need to know of there's reason to think this is an indicator that my tests would be off now when they never have been. Or were you just saying everyone should have routine screening? I'm going out of town and I don't wanna think of myself as sick.
doctor
Answered by Dr. Matthew J. Mangat 7 hours later
Brief Answer:
Have a good holiday.

Detailed Answer:
Hello XXXXXXX
A1C below 7 is fine.
But it should be checked annually. Urine sugar isn't used to diagnose diabetes.
The other tests are advised, if there's been a gap,like in your sugar test.
Kidney problems are not seen in your urine protein report.
You shouldn't be worrying about problems, which don't exist.
Just relax and enjoy life each day. Enjoy watching the sunrise and sunset daily.
Listening music is also advised as part of 'music therapy'.
It stimulates and refreshes one's system.
Personally, i start my day with soft music, to de-stress. Not the loud noisy type.
Wish you a good holiday.

Above answer was peer-reviewed by : Dr. Sonia Raina
doctor
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Follow up: Dr. Matthew J. Mangat 14 hours later
I talked to my doctor about these tests etc and asked him if diabetes could be causing this. I'm also worried about my immune system. He said, like you, quit worrying, this is not a huge deal. He said that, while we should order routine tests, he wouldn't expect anything to be different and that this doesn't indicate that something systemically is going on because I have no fever or other signs of systemic problems. He also said my immune system is fine (he's known me a long time and that I'm rarely sick and, if I am, it's not usually bad). He also said, that if this was from diabetes, he would expect sugar in the urine because that's what would be causing the bacteria to flourish. But no urine test has ever shown glucose. He said, yes, a1c is best measure but, relative to bladder infection, there should be glucose to connect it to diabetes. Besides, I wasn't even pre-diabetic 3 years ago so wouldn't expect such a dramatic change especially since I exercise and am not over weight. Though it is in my family, so I need to check.... But not because of bladder infection (because no urine sugar). Do you agree wit have all this? I hope so because I sure would like to let this go and enjoy my trip out of town next week.
doctor
Answered by Dr. Matthew J. Mangat 23 minutes later
Brief Answer:
With family history of diabetes, annual HbA1C advised.

Detailed Answer:
Hi dear XXXXXXX
Certainly, i would advise you to go ahead and enjoy your hol.next week.
Have a great time.
As you mentioned diabetes runs in your family, on return, check your HbA1C.
Only if the blood sugar goes above a certain level, will it be seen in urine.
And yes, only if present in your system, can it affect the kidneys and urinary system.
As you've not checked for 3 years, don't forget to do it.
If you send me the report, i can give you an expert opinion about it.
Take care.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Matthew J. Mangat 16 minutes later
Just to be clear, if diabetes is causing uti, sugar should be in urine as that would be the cause, correct? That's what my doctor said. So, while we agree that it is prudent to check a1c, it wouldn't be the causative agent here because of lack of urine spill. And do you agree that I should stop worrying about immune system problems etc or systemic problems connected to this? I would be having other problems according to my Dr which I haven't had.
doctor
Answered by Dr. Matthew J. Mangat 4 minutes later
Brief Answer:
Not related to immune system.

Detailed Answer:
Hi XXXXXXX
Don't jump to conclusions.
I've only mentioned about checking your HbA1C, after you return from your hol.
You've misunderstood about diabetes.
It's not the sugar in urine, but diabetes affecting the kidneys and urinary system.
It's first detected in the blood.
Don't worry about immune system.
Hope you've a good holiday. Now relax.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Matthew J. Mangat 56 minutes later
Seems like there would be protein in the urine. And I do know that it's the urine sugar that causes frequency of urination because the body is flushing out the sugar... Also seems like it would take some time to do the damage. And, as I said, no sugar and no protein should atleast be a positive clue that the a1c isn't likely to be too high... Especially since it has never even been borderline....
doctor
Answered by Dr. Matthew J. Mangat 7 hours later
Brief Answer:
You're right finally.

Detailed Answer:
Hi XXXXXXX again.
Now you're on the right track..great.
How did you get so much info. so soon.
At least now you can enjoy thanksgiving peacefully.
Do pray for all poor souls, including this guy, answering your doubts anytime.
Have a great time.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Dr. Matthew J. Mangat

Urologist

Practicing since :1981

Answered : 1897 Questions

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