William Aiken Dear Dr. Aiken:
I am a 20-year-old female and I just read your article about bladder infection. I currently have a urinary tract infection (UTI) for about two weeks and I am worried because it's not going away. I have had UTIs in the past, about three to four years ago, if not more. However, I have had a series of ailments from May 18, 2007. First, I was told I had a fallopian tube infection and was treated for that. Two weeks later, I had excruciating pains along the side and mid area of my abdomen. I later did an ultrasound and they found that I had gall stones for which I was treated.
Two to three weeks later, I again had a series of pains in my lower abdomen and was frequently passing urine. I was examined then told that I have a UTI. The specialist prescribed baralgin and an antibiotic which starts with 'N'. I was fine for only two days, that is, no pain at all. Now I am back to square one with a lot of discomfort and pain. I have another appointment. Also, the last time I had sex was in May.
Please give me your insight in or views on my current problems. Are any of my ailments related to each other? Is there anything simple I can start to do in my life that may help me or slow down the process or even prevent another occurrence?
- Very concerned lady
Dear Very concerned lady:
I am really sorry to hear about all the problems you are having. The lower abdominal pains accompanied by frequent passage of small volumes of urine that you are experiencing is suggestive of a urinary tract infection but could also be due to an infection in the fallopian tubes (salpingitis) or both occurring concurrently.
You do not mention whether there was an associated vaginal discharge which would support a diagnosis of salpingitis. The absence of a vaginal discharge does not, however, exclude the possibility of salpingitis as it may frequently be absent in women with this diagnosis.
Salpingitis, otherwise called pelvic inflammatory disease (PID), is a sexually transmitted infection affecting the fallopian tubes usually caused by gonorrhoea or Chlamydia. You may have acquired this in your last sexual encounter in May and the temporal sequence of events with respect to the onset of symptoms strongly suggests this possibility.
You mentioned that you were prescribed an antibiotic beginning with 'N'. This is likely to be norfloxacin. While this is a good choice for a UTI, it is not such a good choice for PID due to gonorrhoea. The United States Center for Disease Control (CDC) has recently issued an advisory regarding optimal treatment of presumed gonorrohoeal infection. Norfloxacin and drugs of its class like ciprofloxacin, ofloxacin and levofloxacin (the fluoroquinolones) are no longer recommended for empirical treatment of gonorrohea. This is due to a high level of resistance to the aforementioned antibiotics by the germ that causes it. This antibiotic resistance can result in failure of adequate treatment and persistence or early recurrence of symptoms as was the case with you.
I would suggest that you revisit your doctor and request a complete analysis of your urine, including checking for any germs that may be present and determining what antibiotics it is sensitive to. An internal examination as well as samples taken from the neck of the womb may also be helpful in elucidating the cause of your symptoms. Antibiotics could be prescribed which adequately cover gonorrhoea and Chlamydia as well as the common germs which cause UTIs, until the results are back from the lab.
Based on the location of the pain, it is likely that the gallstone which was seen on ultrasound examination is not the cause of it, and appears to be an incidental finding which does not require any treatment.
Urinary tract infections may be minimised by showering before sex, avoiding spermicidal jelly and the diaphragm as contraceptive methods, avoiding douching, passing urine immediately after sexual intercourse, drinking lots of fluids including cranberry juice and not holding your urine for long periods.
In the absence of having one faithful, lifelong partner, use a condom every time in order to minimise your chance of acquiring sexually transmitted infections.
All the best.
- Dr. Aiken
Dr. William Aiken is the head of Urology at the University Hospital of the West Indies and immediate past president of the Jamaica Urological Society; email: yourhealth@gleanerjm.com.
