I have had symptoms for the last year (urinary symptoms, hard/flaccid, pain after ejac., pain in urethra, penis, rectum, and perineum, tight and tender pelvic floor area, yellow semen). I have had two clean urine cultures (both with significantly elevated WBC, but no bacteria in culture); one in June, the other in August. In January, when all this started, my doctor looked at my urine under a microscope and there was no issue (I saw him because of UTI-like symptoms -- pain, difficulty urinating, etc.). To rule out STIs, I had another urine test a couple of weeks ago. The STI test was negative, but my doctor also ran a urine culture which showed "Greater than 100, 000 CFU/mL of Enterococcus faecalis". My current symptoms are not significantly worse than they have been over the last year, although the urine is cloudier and there is a small amount of white discharge (a drop or two), which is why I wanted the STI test. This discharge is marked by a burst of cloudy urine at the beginning of the urination. For a couple of days, however, this discharge was more significant when urinating (mucus, pus, prostatic fluid?) and painful to expel. It was during these days that I had the urine test (it was not mid-stream).
My symptoms have waxed and waned for the last year, never completely going away. Even after taking this latest culture I had two days where I had very little symptoms, and the symptoms have still not returned to the level that they were 2 weeks ago (which were quite severe, especially the pain during urination). Basically, this seems an odd pattern for an infection.
My questions are: (I am raising these with my doctor, just want some basic knowledge first)
- The urine catch was at home, and not clean and not mid-stream. I did that in order to get as much of the cloudiness that appeared at the beginning of urination (I was told that this would show the STIs better). I know that this is not the way a urine sample should be taken for non-STI cultures. Could this be a contamination? Wouldn't a contamination show multiple bacterium? Could this method of catching have exaggerated the amount of e. faecalis?
- How risky would it be to not take ABX and take another culture in a couple of weeks or a month? This test was taken at the height of my most recent flare up of symptoms.
- Can a person's immune system handle an e. faecalis infection in the bladder (which is where my doctor believes this infection is currently residing)? Or is this the kind of infection that really should be treated with ABX?
- I haven't spoken to my doctor yet (he left an email since he is on vacation). He seems to be leaning towards Cefdinir or keflex. Are these particularly good or bad? The susceptibility on the report was AMPICILLIN, NITROFURANTOIN, and VANCOMYCIN.
- If I did have another culture, and it showed less than the 100k mark, would that mean that I am fending off the infection, or are these types of infections variable in terms of bacterial proliferation?
- My doctor stated in the email that this infection is in the bladder, and is easily killed. Is this correct? I know that in the prostate it can be a nightmare, but I thought e. faecalis was stubborn even in the bladder.
Ironically, I have little urethral pain urinating now, and my flow is fairly good. The only symptom I have at the very moment is in the perineum, and a cramping sensation in my rectum, almost like constipation, and a very mild cramping in the lower abdomen. But my symptoms seem to change so frequently that by the time anyone reads this it will probably be completely different. Either way, I don't feel particularly bad right now (a 1-2/10). In fact, this might be the least urination pain I have had in a long time.
I really don't want to take ABX unless necessary, even the milder penicillin types. My gut instinct is that any infection I have is secondary to the primary issues, which I believe to be from muscular issues, stress response, inflammation, and general irritation in the whole area. My doctor is not giving me an actual diagnosis (he's a concierge doctor who I respect, and who is willing to say he doesn't know). He thinks that I may have had an infection at some point, but does not know exactly what I am dealing with. He is not an ABX pusher, but his email suggests that he may be taking a different line on this one.
Prior symptoms over last year: pain in urination from 1-10/10, urethral irritation and pain, poor urine flow, hard/flaccid, frequency, meatus inflammation, red glans, pain after ejac., pain at tip, base, and right side of penis, perineum pain (1-3/10), rectum cramping, hip pain (almost like SI joint pain), groin pain, bloated feeling, general IBS symptoms, dripping sensation even when dry, occasional white drops of discharge, cloudy light colored urine (with floating sediment, bubbles). These symptoms have varied in severity significantly over the last year. They may have begun with a covid infection (I had what appeared to be Covid at the beginning of all of these symptoms). I cannot tolerate hot baths (skin issues), but dry heat is very helpful for all of the symptoms (especially when I sit on the heating pad).
Current symptoms: urinary sediment, possibly some cloudiness at beginning of urination, intermittent cramping/pain in perineum and rectum. Flow is decent, but not as good as it was a couple of days ago, and pain is almost non-existent. Trace to low leukocytes on test strip (when I took the most recent test the leukocytes were at the highest level, but that only lasted for about a day -- before and after the leukocytes went back to between trace and low: the strips I have hard to read at the lower levels). My current symptoms are quite mild relative to the past year, making me even more hesitant to take ABX.
I have been on Bactrim twice. They seemed to help somewhat. However, looking back, I question whether it was the Bactrim, or it was just the ordinary ebb and flow pattern that has occurred over the last 10 months.
I have been treating this through gentle strengthening of hip muscles, walking, diet (an IC diet, basically), meditation (esp. pelvic floor relaxation), and breath work. Stretching is problematic, and I am concentrating more on strengthening first. I usually eat very well, and avoid all irritants (but I do cheat on occasion). I feel like I am getting gradually better (the flares are shorter, and generally not as severe, and the normal times are a little more normal, and seem to last longer). So this latest test has thrown me off balance.
I appreciate any insight.
