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Forum Name: Urinary tract infections

Question: Urinary Tract Infection


 cachaca - Thu Feb 20, 2003 2:46 am

Dear Doctor,
I have Urinary Tract Infection which I suspect to be some sort of STD for more than 3 weeks now. Urine test confirmed that there were some infection as there was a high white blood cell count in my urine. Other tests like VDRL etc was negative.
I was given Amoxycilin for 5 days but that didn't help at all with no improvement but it got worst each day with some sort of pus coming ou from my penist. Then, I changed doctor who then put me on a treatment of single dosage per day of Cephalexin 6 pills of 500mg each and Probencid 4 pills of 250mg and 1 injection of Kanamycin Sulphate. (not sure the amount). I was on that for 11 days and each day it was a lot more better with no signs of further cloudiness in my urine or burning sensation while urine after the very first day of treatment. The second doctor advised that normally it takes about 7 days maximum to cure this sort of bacterial infection. But I went on with the treatment up to 11 days and gave up as I still feel around 1% of uneasiness and when I pass urine, there was a small little sign of contamination in the urine. I confirm this contamination by visual
inspection and normally I could find about 1mmx1mm of transparent coagulated liquid amidst my urine. I then changed to a another doctor who is a specialists and told him the whole story. He then provided me with rifampicin (600mg) per day, tarivid (200mg) for 3 times per day. I took that for 3 days but the moment I start to take his new treatment... I felt my condition immediately worsen rather than improved. So, I went back to the second
doctor and told him I am still not cured completely. He advised that there's nothing better than what he has prescribed and recommended me to continue. I am concern now, is there any maximum period that I can take Cephalexin, Probencid and Kanamycin Sulfate as my treatment? I intend to carry on with this same treatment for another 7 days. It has definitely improved my condition instantaneously. I am worried of liver effects etc if I take too much of antibiotics. What is your recommendation ?
 Dr. Yasser Mokhtar - Thu Feb 20, 2003 2:50 pm

User avatar Dear Cachaca,

Thank you very much for using our website.

You have not mentionned how old are you and whether you have any chronic medical problems or not and why you think that this is an std?

About the std, you mentionned that the vdrl, etc... was negative. What were the other tests that were done? Did the doctor think that this was gonorrhea? Was a swab done to make sure that this was not gonorrhea before starting treatment?

Successful treatment of healthy men less than 50 years of age who have urinary tract infection is usually achieved by the simple administration of a sulfa based medication called bactrim (or septrin in other countries) or any other medication of the tarivid family for 7 days is usually more than enough.

It looks like most of your symptoms are gone. At this point, taking more medications will not add to the cure rate and will add to the risk of more side effects and cost.

My advice at this point is to do another urine analysis and see whether there is still a residual infection in the urine or not and do a urine culture and sensitivty to see if you still have a residual infection which antibiotic affects the bacteria that you have in your urine and take it.

Once more, thank you very much for using our website http://doctorslounge.com and i hope that this information helped.

Yasser Mokhtar, M.D.
 Anonymous - Thu Feb 20, 2003 8:49 pm

Dear Dr. Mokhtar,

Thanks for your prompt reply. I am 28 years old male and do not have any medical problems or allergy to any known medicine. The reason I think this is STD is because I had a burning sensation when I urine and also I had intercourse with my girlfriend. She was also diagnosed to have UTI. But was cured by a week of treatment on Benoxylin. Then, I went for a urine and blood test to confirmed that there was bacterial infection in my urine. The test includes, HIV, VDRL, Chlamydia, Gonorrhea etc. There wasn't a swab test done at all. The country I am presently is probably not capable of doing a swab test, culture, sensitivity test.

I am concerned because I read on some websites that treatment may sometime exceeds more than 14 days. Presently I wouldn't say all the symptoms has gone because of the fact that I can still visually see very minor signs of contamination in my urine. So, I intend to carry on with this treatment of Cephalexin, Probencid and Kanamycin Sulfate for a period of 7 days. I have completed my 2nd day treatment. So another 5 days to go. I don't feel any uncomfort at all.

My question is. Would there be any long term effects since I had such a long treatment on these medication? Also, does it mean that these 3 medication I had is doing good and I should stick on this because it definitely has improved my condition instantaneously and the moment I changed medication my condition became worst. If Cephalexin and Kanamycin Sulfate is doing good to killing this bacteria then there isn't any point for me to change a 5th doctor who may give me something else right?. (I actually saw a 3rd doctor who prescribed me with some other sort of antibiotic which has no effect either). I really appreciate your views.
 Dr. Yasser Mokhtar - Thu Feb 20, 2003 9:35 pm

User avatar Dear Cachaca,

Thank you very much for using our website and thank you for the update.

What i think is, that unless you have some kind of a resistant unusual bug in the bladder causing this infection, you are taking way too many antibiotics. One antibiotic is enough more than enough in cases of simple non-complicated urinary tract infection, on a condition that it is the right antibiotic.

Injections are recommended in cases the patient is not compliant with treatment (in cases of std) and if the patient is very sick and in the hospital.

i think at this point cephalexin is more than enough as it has very good excretion in the urine with very high concentrations and is capable of killing most of the usual bacteria. Kanamycin is not a bad choice either as it has very good concentrations in the urine as well and has good coverage but since you are not really sick, why give you shots?

The usual dose of cephalexin is 250-500 mg orally every 6 hours.

i also recommend drinking a lot of fluids so as to wash out all the infectious agents outside the body.

i also recommend drinking something that will change the pH of urine, if your urine was acidic, then drink something that will render it more alkaline and if it was alkaline then drink something that will make it more acidic (to make it harder for the bacteria to live).

About side effects, too much of anything is not recommended.

Once more, thank you very much for using our website http://doctorslounge.com and i hope that this information helped and waiting for your update.

Yasser Mokhtar, M.D.
 Anonymous - Fri Feb 21, 2003 10:30 am

Dear Dr,

Thanks again for the prompt response. I just had my 3rd treatment of 6x500mg Cephalexin, 4x250mg Probencid and XXXml of Kanamycin Injection. Another 4 more days to go. Honestly, i really don't mind to spend money to get rid of this bacterial infection but am very upset as it has been weeks and there wasn't sign of a complete cure. This time, if I completely the last day, I will just wait for another few days and go do a urine test once more.

In your opinion, looking at the number of days I have had treatment and also various antiobiotics I have had. Do you think I should go as I intend even though if I feel I still have some slight discomfort of 1% and maybe I still see some contamination in my urine I should just ignore those and discontinue medication for a few days before going for a urine test ?

I understand that it is necessary to wait for a few days to a week in order to have a better urine examination for bacterial infection. This was what one of the doctors advised me.

I am really concerned and confused as to what I should be doing as I have seek so many so called "dermatologist" and "urinologist" that is suppose to be the specialist in the country where I am residing.

Really appreciate your help. If I do get some useful recommendation, I would really want to post you all a money order for the advises.

Thanks.
 Anonymous - Fri Feb 21, 2003 11:12 am

Dear Dr,
I forgot to ask. You were mentioning about controlling the pH level of the urine by drinking something. Is there anything I can buy from the Pharmacy for this that you can recommend that goes well with those 2 antibiotics I am taking ? Also, is there a pH paper I can buy from the pharmacy too to do this pH test? I am confused because firstly you mention that if it is alkaline I should drink something more acidic. Then if it is acidic it should make it more alkaline. This will make it hard for the bacteria to live. You mean, I should change the pH level for my urine to the opposite of what it is at present? Which is ideal for bacteria? Acidic or Akaline? Please recommend something for both types if you can. I will go buy some pH paper tomorrow. Thanks.
 Dr. Yasser Mokhtar - Fri Feb 21, 2003 10:28 pm

User avatar Dear Cachaca,

Thank you very much for using our website and thank you for the update.

i never heard of the dose of cephalexin that you are using. This is not the way it is supposed to be used. The does is 250-500 mg orally four times a day.

About the pH, each bacteria has an optimum environment to live and multiply in and if you change this environment (temperature, pH, hydration and others) then the bacteria will not grow and may be even die. This is not a treatment in itself but it is a very helpful tool.

The urine is normally acidic. The pH of the urine should be on the urine analysis that you had at the begining. There are simple things that you can drink to make the urine more acidic like taking vitamin c (its other name is ascorbic acid), to make the urine more alkaline you can take something that contains citrate or bicarbonate like magnesium citrate that is present over the counter in many countries (i do not really know where you are now).

My advice to you is to stop probenecid and kanamycin and take cephalexin the way it is supposed to be taken (500 mg orally every six hours) for a week and by the end of the week go ahead and do a urine analysis without waiting. During this week, drink lots of fluids and if you wish (this is not a crucial step in treatment) take something that will change the pH of the urine.

Once more, thank you very much for using our website http://doctorslounge.com and i hope that this information helped and waiting for your update.

Yasser Mokhtar, M.D.
 Anonymous - Sat Feb 22, 2003 4:53 am

Dear Dr. Mokhtar,

Thanks for your prompt response. I will follow your advise for taking the dosage. I have also checked my original urine analysis and it was pH 8 which represents an alkaline urine. I will thus take some vitamin C as advised. I believe for all Bacterial infection, maintaining an acidic urine is a good choice? Also, should I start a complete 500mg 6 hours interval for 7 days?

Today, i received my blood test results for HSV Type 1 and 2 IgG reactivity which requires about 2 weeks for the lab to produced here. They have confirmed that I have HSV Virus Type 1 Titer 1:100 Week Positive Antibodies present. Type 2 was negative. The doctor there told me not to worry as long as there are no symptoms of herpes externally in my body. Which there isn't at all. I have not remember any incident of having lesions externally that looks like herpes infection in my past 28 years of life. I am very worried now because I do not involve in casual sex but only with my girlfriend. What can I do at the moment for this HSV test? The doctor say I don't have to do anything since the test only showed some week antibodies present in my blood. The scales provided in the results are (IgG Reactivity: No reaction at 1:100 refers to Negative. Titer 1:100 to 1:320 Refers to Positive Former or Recent Infection. Titer 1:1000 or higher Refers to Recent infection).

For your information, the last time I had intercourse was probably about a week before I did the blood test.

Anyway, this may be not relevant to the UTI at all? I have also managed to find a lab that can do Bacteria Culture and Sensitivity Test here. Though they said it may not have any results as I am still on antibiotics but I told them to give it a go.

I really want to get rid of all these things in my body as I consider myself a healthy person and it is really upset to know the fact that it is STD related.

Please advise what I can do with the HSV results. Thanks a lot.
 Dr. Yasser Mokhtar - Sat Feb 22, 2003 7:11 pm

User avatar Dear Cachaca,

Thank you very much for your reply and for using our website.

Regarding the antibiotic, yes, i think you should start a full course of cephalexin 500 mg every 6 hours for 7 days.

Regarding herpes antibody results, hsv type 1 is the type that causes the cold sores on the mouth.

Hsv type 2 is the one that causes the genital infection in most of the cases. It is rare to have someone with genital lesions and has type 1 infection.

You have weakly positive type 1 and negative type 2 which means that you most probably had a cold sore sometime in the past but no genital herpes.

From now on, i think it is not unreasonable to practice safe sex.

About the urine culture and sensitivity, i think the lab is right about most probably not finding anything in the urine because of the antibiotics (unless this is the specimen that you gave before starting the antibiotics).

Once more, thank you very much for using our website http://doctorslounge.com and i hope that this information helped and waiting for your update.

Yasser Mokhtar, M.D.
 Anonymous - Sun Feb 23, 2003 11:18 am

Dear Dr.,

Thanks for your information about my HSV results. Seemed like even the doctor here didn't even tell me it could probably just be a cold sore in my mouth !. But I am very reliefed now.

I will complete the 7 days of antibiotic as you advised. By the way, I found a website that seemed to recommend the same single dosage method as advised by this doctor I had here. Click here!

But. I will let you know my progress at the end of the 7 days with 500mg in 6 hours interval. So far after 6 times of 500mg... I still see some transparent looking thing in my urine and still have a little bit of discomfort in my urethra. This thing in my urine looks like some sort of mucous but it is normally around 1mmx1mm but sometimes can be around 1mmx20mm. I suppose these are the bacteria? I read that normal urine should be sterile and shouldn't have anything in it.

Thanks a lot.
 Dr. Yasser Mokhtar - Sun Feb 23, 2003 8:14 pm

User avatar Dear Cachaca,

Thank you very much for your reply and for using our website.

About cephalexin dose in the link that you sent me, it says that in cases of genitourinary infections the dose is 1-2 grams (1000-2000 mg)/day in divided doses given every 6-8 hours. This means a dose of 250-500 mg every 6 hours.

About the single dose, this means that you take this dose one time only and not once every day for 14 days and this regimen is only used in cases of gonorrhea and you said that you testes negative for gonorrhea.

The mucous that you are seeing in the urine could be protein in the urine from the infection or could be clumps of cells.

The best way to find out whether you have been cured regardless of the symptoms and what you see in the urine is a urine analysis.

Once more, thank you very much for using our website http://doctorslounge.com and i hope that this information helped and hoping that you will feel better soon.

Yasser Mokhtar, M.D.
 Anonymous - Wed Feb 26, 2003 6:20 am

Dear Dr,

4 days has past since I started taking the Cephalexin at the recommended dosage. I have been getting a lot better or at least I felt that way. I am wondering, with the amount of antibiotics I have been taking for such a long time.. (26 days?), would you recommend me to eat some acidophulus supplement? I don't have any pain or whatsoever in my stomach and I go to the toilet regularly. But psychologically i am worried that I should be eating something useful to help my dietary system.
If you can recommend me something that would be really useful or food that I should avoid or eat more etc. I know anything sweet is not good as it would encourage the growth of bacteria in the urinary tract.

Thanks a lot.
 Dr. Yasser Mokhtar - Fri Feb 28, 2003 8:57 pm

User avatar Dear Cachaca,

i am happy that you are feeling better and i hope that you continue to improve.

There is no specific diet that you can follow while taking anntibiotics, all i can say is that you have to eat a healthy well balanced diet to keep your body as healthy as possible while fighting the infection.

Thank you very much for using our website http://doctorslounge.com and i hope that this information helped.

Yasser Mokhtar, M.D.

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