Chronic Bladder Infection: Why Bacteria Cultures Fail and What to Do - Urology

Recurrent cystitis for two months, with urine tests showing bacteria sometimes and not at other times. Bacterial cultures have consistently failed to grow any bacteria, making it difficult to target the treatment effectively..?

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Hello Doctor, I have been experiencing recurrent urinary tract infections for two months.
Sometimes bacteria are present in my urine tests, and sometimes they are not.
Bacterial cultures have consistently failed to grow any bacteria.
I would like to inquire about possible reasons for this situation.
Thank you, Doctor! Here is my medical history:
On October 1st, I had an acute bladder infection and took antibiotics (Ampicillin capsules 500mg) for 10 days, which improved my condition.
However, on October 12th, I started experiencing frequent urination and dull pain in both sides of my lower back (not tenderness upon percussion).
I went to the emergency room at night and received a three-day prescription (Moxifloxacin tablets), but there was no improvement (in the past, my bladder infections would improve immediately after the first dose of medication, but this time it did not).
On October 13th, I visited the outpatient clinic for a medication change (Tamsulosin extended-release tablets 250mg).

On October 19th, during a follow-up visit, the report indicated Gardnerella vaginalis, and I changed medications (Doxycycline capsules, 250mg).
On October 26th, I returned for another follow-up and received another three-day prescription (Doxycycline capsules, 250mg).
On October 30th, I began experiencing frequent urination again in the early morning.
I visited the outpatient clinic, but my urine test was clean, and I did not receive antibiotics.
On November 6th, I had extreme frequency of urination, feeling the urge to urinate immediately after finishing.
I went to the emergency room again, where the urine test showed bacteria, and I received medication (Ciprofloxacin extended-release tablets 500mg).
On November 9th, during a follow-up visit, the report indicated Proteus mirabilis, and I changed medications (Nitrofurantoin tablets 400mg).

On November 10th, I experienced severe dull pain in my lower back at night, which was so intense that I could not sleep.
I went to the emergency room and received a medication change (Cefdinir extended-release tablets 250mg).
After taking the medication, there was no improvement, so I returned to the outpatient clinic for a bacterial culture.
My blood test showed elevated neutrophils and low lymphocytes, and I changed medications (Norfloxacin extended-release tablets 1000mg).

On November 15th, during a follow-up visit, the report stated that no bacteria could be cultured.
The doctor advised me to take the same medication (Norfloxacin extended-release tablets 1000mg) for another three days.
After a four-day break from medication, I returned on November 19th, and my bladder started feeling strange again, with a lot of white, thin, floating particles in my urine.
After drinking plenty of water and urinating several times, it went away.

On November 22nd, I still felt a dull sensation in my bladder, so I returned for another visit.
The urine test showed bacteria, and I underwent another bacterial culture, changing medications (Amoxicillin extended-release tablets 625mg).
On November 27th, I experienced frequent urination again at night, and during the day, I noticed some white, thin, floating particles in my urine.
After drinking plenty of water and urinating several times, it went away.
I returned early for a follow-up, and the urine test showed bacteria, with elevated neutrophils and low lymphocytes in my blood.
The doctor changed my medication (Ciprofloxacin 100mg).
On December 2nd, I felt significantly better, with almost no discomfort.
However, on December 3rd, my menstrual period started, and I immediately experienced soreness and frequent urination in my lower abdomen.
On December 4th, my condition improved slightly compared to the previous day, but I still felt unusual sensations in my bladder.
The urine test showed no bacteria, and the previous week's report indicated that no bacteria could be cultured.
The doctor advised me to take a three-day course of medication (Cefixime capsules) and to return for a follow-up after a day off from medication.
On December 8th, my condition stabilized somewhat, but I still felt unusual sensations in my bladder.
During the follow-up, the urine test showed no bacteria, but my blood test indicated elevated neutrophils and low lymphocytes.
The doctor prescribed another seven-day course of medication (Cefdinir extended-release tablets 250mg).
During this period, I underwent a kidney ultrasound, which revealed small stones and hydronephrosis.
The doctor prescribed medication for this and suggested that I take the medication to alleviate symptoms before undergoing pyelography, urodynamics, and urine cytology tests.
The reports indicated no significant issues.

The bacterial cultures, except for Gardnerella vaginalis on October 13th and Proteus mirabilis on November 6th, have not yielded any growth despite multiple attempts.
Therefore, I am unsure if I am infected with other bacteria or if the bacteria have developed resistance.
I have been drinking plenty of water, not holding my urine, exercising regularly, and practicing proper hygiene, yet I do not understand why I have not fully recovered after two months.
I suspect that the oral antibiotics may not be strong enough, but I have been unable to get admitted to the hospital for over two weeks.

P.S.
The unusual sensation in my bladder occurs when I start to feel the urge to urinate, around the urethra area, where I experience a slight soreness.
After urinating, there is also a bit of soreness.
This symptom does not persist throughout the day; it may suddenly appear for half a day and then disappear, which I find very strange.
When the symptoms flare up, it is difficult to concentrate, and it somewhat affects my daily life.
I am very worried that this might be my condition for life.

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07, 20~29 year old female. Ask Date: 2023/12/08