Managing Recurring High Fever and Urgency: A Urology Perspective

Management of recurrent high fever and urgent urinary frequency?

Due to work commitments, I am currently in Germany and will not be able to return to Taiwan for about two weeks.
I would like to consult a physician regarding emergency measures and follow-up procedures.
Ten years ago, I experienced symptoms such as hematuria and frequent urination, which resolved after medication.
Two years ago, after moving abroad, I had a recurrence of hematuria, which also resolved with antibiotics.
Recently, when I feel fatigued, I experience mild fever and increased urgency to urinate.
Since the symptoms were mild, I did not seek medical attention.
However, a year ago, I became extremely fatigued and one day started experiencing high fever (over 40°C), chills, and fainting.
This occurred two to three times a day for several days until I was unable to walk and finally went to the hospital.

Ultrasound, blood tests, and urinalysis were performed, and prior to the onset of my illness, I did not have frequent urination symptoms; these only began after I fell ill (without hematuria).
The doctors could not identify the cause of the fever and only administered antipyretics.
Urinalysis confirmed an infection, and I was treated with antibiotics.
After about seven days, the fever subsided, and I was discharged (the antibiotics given abroad seemed to be less aggressive).
Later, I returned to Taiwan and consulted a doctor who mentioned that urinary tract infections can only be detected during an active episode.
However, my fatigue and mild fever have persisted and are becoming increasingly severe.

Due to frequent business trips, I am concerned about not being able to seek medical attention in time, so I brought along some antibiotics (the type starting with "V" for urinary tract infections purchased from a pharmacy in Taiwan).
A few days ago, after arriving in Germany and feeling extremely fatigued, I started experiencing high fever again, chills, and fainting until I fell asleep.
Subsequently, I had increased urgency to urinate.
Since it is difficult to seek medical care on weekends abroad, I began taking antibiotics and acetaminophen for the fever, which seems to have reduced the high fever.
However, I start to feel feverish again whenever I get tired, making it impossible to work (I spent two hours writing this message).
I am also worried that the frequent urination symptoms will soon appear.

I have an important work commitment starting Monday.
Could you please advise me on what methods I can use to manage this situation? Do I need to seek medical attention immediately? When I return to Taiwan in two weeks, which department should I consult? What symptoms should I report? Currently, I do not have any other illnesses; everything else is normal (heart rate, blood pressure, etc.).
Thank you.

Debbie, 30~39 year old female. Ask Date: 2004/10/23

Dr. Zhang Chengye reply Urology

Possible cystitis with acute nephritis; urine tests should be conducted for confirmation before initiating antibiotic treatment.
Refer to urology or infectious disease specialists.
The patient reports symptoms of frequent urination and fever.

Reply Date: 2004/10/23

More Info

Managing recurring high fever and urinary urgency can be quite challenging, especially when you are away from home and dealing with a complex medical history. Based on your description, it seems you have a history of urinary tract infections (UTIs) and have experienced significant symptoms, including high fever, chills, and fatigue. Here’s a comprehensive approach to managing your situation.

Immediate Steps to Take
1. Monitor Symptoms: Keep a detailed log of your symptoms, including the frequency of fever, any urinary urgency, and other associated symptoms like chills or fatigue. This information will be crucial for any healthcare provider you consult.

2. Hydration: Ensure you are drinking plenty of fluids. Staying hydrated can help flush out bacteria from your urinary tract and may alleviate some of the symptoms associated with UTIs.

3. Rest: Given that you mentioned feeling fatigued, prioritize rest. Your body needs energy to fight off any potential infections.

4. Over-the-Counter Medications: Continue using over-the-counter medications like ibuprofen or acetaminophen to manage fever and discomfort. However, be cautious with self-medication, especially if you have underlying health conditions or are taking other medications.

5. Antibiotics: Since you have previously used antibiotics for UTIs, it’s important to note that self-prescribing antibiotics can lead to antibiotic resistance. If you feel that your symptoms are worsening or not improving, it’s crucial to seek medical attention rather than relying solely on previously prescribed antibiotics.

When to Seek Medical Attention
- High Fever: If your fever exceeds 39°C (102°F) and does not respond to over-the-counter medications, seek medical attention.

- Severe Symptoms: If you experience severe abdominal pain, persistent vomiting, or any signs of confusion or altered mental status, these could indicate a more serious infection or complication.

- Duration of Symptoms: If your symptoms persist for more than a couple of days without improvement, it’s advisable to consult a healthcare provider.

Follow-Up Care in Taiwan
When you return to Taiwan, you should consider visiting a urologist or an infectious disease specialist. Here’s how to prepare for your appointment:
- Document Symptoms: Bring your symptom log, including details about your fever, urinary urgency, and any treatments you have tried.

- Medical History: Be prepared to discuss your medical history, including previous UTIs, treatments, and any other relevant health issues.

- Tests: Ask about urine cultures and sensitivity tests to determine the specific bacteria causing your infection and which antibiotics would be effective.

Potential Investigations
Given your history of recurrent UTIs and the complexity of your symptoms, your doctor may recommend:
- Urinalysis and Urine Culture: To identify any bacterial infection.

- Imaging Studies: Such as an ultrasound or CT scan to rule out any anatomical abnormalities in the urinary tract.

- Blood Tests: To check for signs of infection or other underlying conditions.

Conclusion
Managing recurring high fever and urinary urgency requires a proactive approach, especially when traveling. Keep track of your symptoms, stay hydrated, and do not hesitate to seek medical attention if your condition worsens. Upon returning to Taiwan, consult a urologist or an infectious disease specialist for a thorough evaluation and tailored treatment plan. Your health is paramount, and addressing these symptoms early can prevent complications.

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