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Suggest Treatment For Pain And Bleeding During Urination
Question: Greetings. On Saturday night XXXXXXX 13 I experienced pain and bleeding while urinating (no other pain), but it stopped within a few hours in the middle of the night. On XXXXXXX 14 I did a urine test (attached) for which I was prescribed 10 days of Cipro.
Although I had no more pain or bleeding during urination after XXXXXXX 13 I still had some malaise and fever that continued until XXXXXXX 18, on which date the doctor decided to switch me off Cipro and on to Macrobid for 10 days, and I did another urine test culture and a blood test. The fever and malaise started to go away fairly quickly.
I finally received the results of the culture on XXXXXXX 25. But the doctor told me to finish the Macrobid anyway. The attached tests indicate the elevated PSA (presumably due to the UTI)because of which the doctor recommends another blood test in a month. I had had a blood test in April showing a usual low PSA (< 1.0).
I am attaching the tests for your input into the situation. Was I resistant to Cipro which is why I still had a fever on Day 4 of Cipro which went down a day or two into Macrobid, and why I had ranges suggestive of continued infection 4 days full days after taking Cipro? I feel fine now.
I initially asked Dr. Gibson about this condition, but now I have received the actual reports that I have just uploaded with a summary of what happened. I am particular interested that the report shows continued bacteria and other indicators related to the UTI even after 4 days of Cipro before replacing it with Macrobid.
Although I had no more pain or bleeding during urination after XXXXXXX 13 I still had some malaise and fever that continued until XXXXXXX 18, on which date the doctor decided to switch me off Cipro and on to Macrobid for 10 days, and I did another urine test culture and a blood test. The fever and malaise started to go away fairly quickly.
I finally received the results of the culture on XXXXXXX 25. But the doctor told me to finish the Macrobid anyway. The attached tests indicate the elevated PSA (presumably due to the UTI)because of which the doctor recommends another blood test in a month. I had had a blood test in April showing a usual low PSA (< 1.0).
I am attaching the tests for your input into the situation. Was I resistant to Cipro which is why I still had a fever on Day 4 of Cipro which went down a day or two into Macrobid, and why I had ranges suggestive of continued infection 4 days full days after taking Cipro? I feel fine now.
I initially asked Dr. Gibson about this condition, but now I have received the actual reports that I have just uploaded with a summary of what happened. I am particular interested that the report shows continued bacteria and other indicators related to the UTI even after 4 days of Cipro before replacing it with Macrobid.
Brief Answer:
I think we need to look into your prostate and renal tract
Detailed Answer:
Hello sir and welcome.
Thank you for writing to us.
I have gone through your query with diligence and would like you to know that I am here to help. From your input and the attached reports I do not see any infection anywhere. I would like to say that the culture also does not prove any particular infection, either because the culture was taken while you were on medications or because the culture was itself taken when you did not in fact have an infection.
As your doctor also did not see the reason to continue the antibiotics even after the culture report was in, I am sure he did not see the requirement yet still wanted you to continue with the antibiotics just in case.
But in my opinion, as there is no proof of any infection anywhere I think we should be looking at your prostate and your renal tract with the help of an ultrasound KUB (kidney, ureter, bladder) and an ultrasound of your prostate.
So please do discuss this with your doctor. I think the cause for the bleed also lies there. Please feel free to write back to me for any further clarifications, I would be more than happy to help.
Best wishes.
I think we need to look into your prostate and renal tract
Detailed Answer:
Hello sir and welcome.
Thank you for writing to us.
I have gone through your query with diligence and would like you to know that I am here to help. From your input and the attached reports I do not see any infection anywhere. I would like to say that the culture also does not prove any particular infection, either because the culture was taken while you were on medications or because the culture was itself taken when you did not in fact have an infection.
As your doctor also did not see the reason to continue the antibiotics even after the culture report was in, I am sure he did not see the requirement yet still wanted you to continue with the antibiotics just in case.
But in my opinion, as there is no proof of any infection anywhere I think we should be looking at your prostate and your renal tract with the help of an ultrasound KUB (kidney, ureter, bladder) and an ultrasound of your prostate.
So please do discuss this with your doctor. I think the cause for the bleed also lies there. Please feel free to write back to me for any further clarifications, I would be more than happy to help.
Best wishes.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you Dr. XXXXXXX but I am more confused than before. I was originally put on Cipro after they did the first handwritten urine test, having a period of hours of bleeding and pain at the end of urine stream. I took Tylenol and it subsided before I started the Cipro, but I still had the malaise and some fever (up to 101.5).
On day 4 I was switched to Macrobid because I still had some fever (99-100), which seemed to have subsided within about 24 hours on the Macrobid. The second urine test and blood test were done on Day 4 before starting the Macrobid. I continued the Macrobid for the full 10 days, and saw no more pain or blood, or fever or malaise. I feel fine now.
The second urine test indicates "few" under the category of bacteria with some other elevations or lower numbers of several things including PSA (which seem rather insignificant). I never had any back pain or abdominal pain. I will retake the blood and urine test at the end of July before going to the urologist. My PSA has never reached 1.0 including in April when I had a blood test for life insurance.
I am very confused. Especially since I don't understand even how I contracted whatever it was in the urinary system.
Indeed, isn't seeing visible blood, pain and fever symptomatic of a bacterial infection that would be indicated on the first in-office urine test? And then again on the urine culture lab test that has various numbers indicative of UTI infection (few bacteria and slightly elevated PSA, etc.).
On day 4 I was switched to Macrobid because I still had some fever (99-100), which seemed to have subsided within about 24 hours on the Macrobid. The second urine test and blood test were done on Day 4 before starting the Macrobid. I continued the Macrobid for the full 10 days, and saw no more pain or blood, or fever or malaise. I feel fine now.
The second urine test indicates "few" under the category of bacteria with some other elevations or lower numbers of several things including PSA (which seem rather insignificant). I never had any back pain or abdominal pain. I will retake the blood and urine test at the end of July before going to the urologist. My PSA has never reached 1.0 including in April when I had a blood test for life insurance.
I am very confused. Especially since I don't understand even how I contracted whatever it was in the urinary system.
Indeed, isn't seeing visible blood, pain and fever symptomatic of a bacterial infection that would be indicated on the first in-office urine test? And then again on the urine culture lab test that has various numbers indicative of UTI infection (few bacteria and slightly elevated PSA, etc.).
Brief Answer:
More clear now; yes you could have been partially or completely resistant
Detailed Answer:
Hello once again.
Things were unclear without more details on the situation. What I based my previous reply on was the fact that the reports did not really show much.
But with the elaborate description, I now understand the situation better. Yes, it is quite possible that you could have been resistant to cipro which is why your fever and other symptoms mildly still persisted. There is also a possibility that you could have been mildly resistant to cipro and not completely resistant to it which is why you may have mildly recovered while on it.
In majority of cases, a response is observed over the first 24-48 hours which you did not experience while on the ciprofloxacin. But as soon as you were shifted on to the Macrobid you experienced a response, which does indicate an improvement and susceptibility to that antibiotic.
However, I would still recommend the two ultrasounds that I advised in my previous response sir. Please feel free to write back to me for any further clarifications, and also please forgive me if I did not reply as expected in my previous response due to the insufficient information that I had at hand, my sincere apologies.
Best wishes.
More clear now; yes you could have been partially or completely resistant
Detailed Answer:
Hello once again.
Things were unclear without more details on the situation. What I based my previous reply on was the fact that the reports did not really show much.
But with the elaborate description, I now understand the situation better. Yes, it is quite possible that you could have been resistant to cipro which is why your fever and other symptoms mildly still persisted. There is also a possibility that you could have been mildly resistant to cipro and not completely resistant to it which is why you may have mildly recovered while on it.
In majority of cases, a response is observed over the first 24-48 hours which you did not experience while on the ciprofloxacin. But as soon as you were shifted on to the Macrobid you experienced a response, which does indicate an improvement and susceptibility to that antibiotic.
However, I would still recommend the two ultrasounds that I advised in my previous response sir. Please feel free to write back to me for any further clarifications, and also please forgive me if I did not reply as expected in my previous response due to the insufficient information that I had at hand, my sincere apologies.
Best wishes.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you very much, this is greatly appreciated.
Now, if the first urine test showed "medium leukocytes", and the second after 4 days of cipro showed some other indicators of infection before starting the Macrobid, but the pain and visible blood had stopped even before starting the Cipro, what type of situation might this refer to in infection when I had no nausea, no back or stomach pain, but only during end of urination with blood for several hours which then stopped? With only the continuation of some malaise and fever?
I guess this becomes somewhat mysterious because I still have to wait another few weeks to test the blood and urine again after completing the Macrobid, especially for the purpose of PSA (Free 7.63 and Total 2.57) and the slight increase in microalbumin (23.0). And aren't some urine RBC's after 4 days of cipro - 0-2, slight changes in thyroid 3 etc., and "few" urine bacteria suggestive of infection? I am glad that at least now I feel my usual self........
Now, if the first urine test showed "medium leukocytes", and the second after 4 days of cipro showed some other indicators of infection before starting the Macrobid, but the pain and visible blood had stopped even before starting the Cipro, what type of situation might this refer to in infection when I had no nausea, no back or stomach pain, but only during end of urination with blood for several hours which then stopped? With only the continuation of some malaise and fever?
I guess this becomes somewhat mysterious because I still have to wait another few weeks to test the blood and urine again after completing the Macrobid, especially for the purpose of PSA (Free 7.63 and Total 2.57) and the slight increase in microalbumin (23.0). And aren't some urine RBC's after 4 days of cipro - 0-2, slight changes in thyroid 3 etc., and "few" urine bacteria suggestive of infection? I am glad that at least now I feel my usual self........
Brief Answer:
Queries addressed sir
Detailed Answer:
Hi.
This scenario would indicate a 'mildly resistant' status to ciprofloxacin in my opinion.
Yes, you will have to repeat the tests to make sure:
1. Your symptom has been completely treated
2. The elevated PSA was because of the infection (which is normal as the prostate is part of the urinary tract) or whether the elevation was in fact due to a prostate abnormality
Yes, but may be that is because the treatment has not been completed yet, and so let us wait for the next investigation to confirm the association. I am glad too that that you are much more comfortable now.
Best wishes.
Queries addressed sir
Detailed Answer:
Hi.
This scenario would indicate a 'mildly resistant' status to ciprofloxacin in my opinion.
Yes, you will have to repeat the tests to make sure:
1. Your symptom has been completely treated
2. The elevated PSA was because of the infection (which is normal as the prostate is part of the urinary tract) or whether the elevation was in fact due to a prostate abnormality
Yes, but may be that is because the treatment has not been completed yet, and so let us wait for the next investigation to confirm the association. I am glad too that that you are much more comfortable now.
Best wishes.
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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