Recurrent Urethritis: Symptoms, Causes, and Treatment Options

Q: Recurrent Urethritis: Symptoms, Causes, and Treatment Options

It sounds like prostatitis, and the bacteria cultured may be from the feces. <br>May I ask if there has been any anal intercourse? These bacteria could potentially have strong antibiotic resistance, and a stronger medication may be required, with treatment lasting 4 to 6 weeks. <

Recurrent urethritis

Hello Doctor, I have a normal daily routine and drink water adequately.
I only have sexual intercourse with my wife, which is not frequent (about once a week).
Around August 15, I experienced acute urethritis for the first time in my life.
I visited a nearby clinic, where a urine test showed white blood cells >50.
I took antibiotics for 9 days and returned to normal.
After discovering the urethritis, I was worried about transmitting it to my wife, so we paused sexual activity.
On September 1, I experienced fever and chills again, so I went to the clinic, and the doctor suggested I go to a larger hospital for a kidney stone examination.
I underwent a urinary tract imaging study at the hospital, which showed no abnormalities or stones.
I then took antibiotics for another two weeks and my health returned to normal.
By October 1, I had fever and chills again, and this time my urine turned brownish-red with blood.
I went back to the hospital for examination, and the doctor indicated that blood in the urine is a common symptom of urinary infection, but the recurrent infections were concerning.
A urine culture was performed, showing Escherichia coli < 100,000/ml and Enterococcus faecalis 30,000/ml.
The doctor felt further investigation was necessary, particularly regarding my kidneys, so a CT scan was arranged.
I was advised to continue antibiotics but at half the dosage.
The results were normal, and the doctor mentioned that he could only identify the issue through exclusion, suspecting inflammation in the left renal cyst (two 4.5 cm cysts) that I have had since 2017.
He wanted to schedule a cystoscopy to aspirate the renal cyst, but due to a lack of hospital beds, it has not yet been done, and I am waiting for notification.
I looked up information online and wondered if it could also be a prostate issue, so on October 26, I visited a urologist at the same hospital for a prostate examination.
The doctor reviewed my previous CT scan and blood tests and noted that I had not had a PSA test, so blood was drawn for that, resulting in 1.807 ng/ml.
A cystoscopy was then scheduled, followed by a digital rectal exam (which is arranged but not yet performed).
The doctor advised me to continue taking antibiotics, so I resumed taking them.
Each time, I was prescribed the antibiotic - Hicor 250 mg.
I have followed the doctor's instructions regarding usage and discontinuation, but I later found online that if it is prostatitis, a long course of antibiotics is needed, so I sought a second opinion from another urologist.
I have started feeling chills again (this time without fever) and have experienced dizziness for over a week (since October 24, 2022).
I generally feel dizzy starting around noon, and my lower limbs feel cold (the weather is not particularly cold).
I am unsure what to do.
My questions are: 1.
Could this be chronic prostatitis? 2.
Both doctors have scheduled cystoscopy; is there any issue with having consecutive cystoscopies? 3.
Should I also see a nephrologist? I read online that chills and dizziness could indicate kidney problems.
4.
I am very concerned that a delay in treatment could lead to kidney issues, or that taking too many antibiotics could harm my kidneys.
5.
I worry that taking antibiotics might lead to bacterial resistance, necessitating a change in antibiotics (current courses: 9 days / 14 days / 14 days / 7 days).
6.
Could the dizziness be a side effect of the antibiotics? 7.
My wife is asking if we can still have sexual intercourse during this period, as we have plans to have children and are concerned about age affecting fertility.
I have written a lot, and I appreciate the time you took to read this.

Niming, 40~49 year old female. Ask Date: 2022/10/31

Dr. Li Xinyi reply Urology

It sounds like prostatitis, and the bacteria cultured may be from the feces.
May I ask if there has been any anal intercourse? These bacteria could potentially have strong antibiotic resistance, and a stronger medication may be required, with treatment lasting 4 to 6 weeks.
It is still necessary to see a urologist for further examination and to discuss with the physician.

Reply Date: 2022/10/31

More Info

Recurrent urethritis can be a challenging condition to manage, especially when it leads to multiple episodes of infection and associated symptoms. Based on your detailed account, it appears that you have experienced several episodes of acute urethritis, which has raised concerns about potential underlying issues, such as chronic prostatitis or kidney problems. Let’s address your questions and provide some insights into the management of recurrent urethritis.

1. Could this be chronic prostatitis?
Chronic prostatitis is indeed a possibility, especially given your recurrent symptoms and the bacterial cultures showing the presence of Enterococcus faecalis. Chronic prostatitis can manifest with symptoms such as pelvic pain, urinary difficulties, and sometimes systemic symptoms like fever and chills. It is important to note that chronic prostatitis can be difficult to diagnose and may require prolonged antibiotic therapy, often lasting several weeks to months. Your symptoms of chills and dizziness could potentially be related to prostatitis, but they could also stem from other causes, including the effects of antibiotics or other infections.

2. Is it safe to undergo cystoscopy multiple times?
Cystoscopy is a relatively safe procedure, but like any medical intervention, it does carry some risks, including infection and bleeding. If your doctors have recommended this procedure, it is likely because they believe it is necessary for further evaluation of your urinary tract and potential sources of infection. Discussing your concerns with your urologist can help clarify the necessity and frequency of the procedure.

3. Should I see a nephrologist?
Given your symptoms of chills and dizziness, along with your history of kidney cysts, it would be prudent to consult a nephrologist. They can evaluate your kidney function and assess whether there are any underlying issues that might be contributing to your recurrent infections or systemic symptoms. Kidney problems can sometimes manifest with nonspecific symptoms like fatigue and chills, so a thorough evaluation is warranted.

4. Am I at risk of delaying treatment that could harm my kidneys?
It is understandable to be concerned about the potential for kidney damage due to recurrent infections or prolonged antibiotic use. While acute urinary tract infections typically do not lead to kidney damage if treated promptly, recurrent infections can pose a risk if they are not adequately managed. It is crucial to follow up with your healthcare providers to ensure that any underlying issues are addressed and that you receive appropriate treatment.

5. Could antibiotic use lead to resistance?
Yes, prolonged or repeated use of antibiotics can lead to bacterial resistance. This is a significant concern in the treatment of urinary tract infections. If you find that your symptoms persist despite antibiotic treatment, it may be necessary to perform sensitivity testing on the cultured bacteria to determine the most effective antibiotic. Your healthcare provider may also consider alternative antibiotics or treatment regimens to mitigate the risk of resistance.

6. Is dizziness a side effect of antibiotics?
Dizziness can be a side effect of some antibiotics, although it is not common. It may also be related to other factors, such as dehydration, electrolyte imbalances, or even the underlying infection itself. If you suspect that your dizziness is related to antibiotic use, it is important to discuss this with your doctor.

7. Can I continue sexual activity during this period?
This is a sensitive topic, especially considering your plans for family expansion. It is generally advisable to avoid sexual activity during active infections to prevent transmitting bacteria to your partner and to allow your body to heal. Once your symptoms have resolved and you have consulted with your healthcare provider, you can discuss when it would be safe to resume sexual activity.

In summary, recurrent urethritis can be complex, and it is essential to work closely with your healthcare team to identify the underlying causes and develop an effective treatment plan. Regular follow-ups, appropriate diagnostic testing, and open communication with your doctors will be key to managing your condition effectively.

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