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Urology/UTI or Yeast Infection?

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Question
On Friday after having fairly rough sex with my fiance (I do suspect I wasn't lubed enough), I had painful urination. It stung pretty sharply and severely but as that sometimes happens to me and as it didn't reoccur for the rest of the day I didn't think much of it. But the next day it happened again, even when not urinating. The stinging feels almost as if I was being cut by something sharp. Ever since then I have been feeling "off" down there - itching, burning, and stinging that does seem to get worse when I urinate. I'm not sure but I think I have the urge to urinate more frequently than usual. However I have had a UTI before and it is nowhere near that uncomfortable or severe and I have visited a doctor last year or so for similar symptoms (including frequent urination) suspecting it was a UTI but after testing for it, there wasn't any evidence for it being so. Therefore I'm not sure if it is really a UTI or if it could be a yeast infection - I have had just a little yellowish-orange discharge - or even something else. As the yeast infection kits are expensive I'd rather not buy one if the chances of it working are slim. I'm also not sure then whether to go to the doctor (if it's necessary) at the Women's Clinic or the general practice doctors. It shouldn't be an STD as I've only ever had one partner and he's been tested and we use a condom every time. What do you suspect it could be? What doctor should I see? And is it worth trying to treat it with a yeast infection kit?

Answer
Sarah, yeast infections in woman present with a thick, whitish curd like vaginal discharge accompanied by vaginal itching.  There may or may not be associated urinary symptoms.  From your description, I think a yeast infection is unlikely.  You probably have a UTI or an inflammation of the urethra (urethritis) from either infection or trauma from the sexual activity.  Regardless, I would suggest you see a physician (preferably a urologist) for an examination and at the very least a urinalysis.  This should lead rather easily to a proper diagnosis.  After that, treatment can be more soundly recommended.  

Urinary tract infections (UTIs) in women are very common compared to men.  This is due to the relatively short length of the female urethra.  This results in the bladder being nearer the external environment.  The most likely sources of bacteria are from the rectum, colonization in the vagina, or introduction via sexual activity.  Frequent bathing, as opposed to showering, also allows bath water to reflux into the bladder.  This may also be an entry path for bacteria.  In addition, refluxed soap residues often will irritate the lining of the bladder and urethra (mucosa) causing symptoms.  Females can lessen the likelihood of infection by not ignoring the desire to void, by emptying the bladder just prior to and soon after intercourse, by taking showers rather than baths and by always wiping from the urethra toward the rectum – NEVER the reverse!  The use of a diaphragm and spermicidal jellies also increase the risk of UTIs.  The typical symptoms of a UTI are frequency, burning, and urgency.  With more severe inflammation, blood may appear in the urine.  If bleeding occurs, you should seek consultation with a urologist once you are better to ensure that there are no other causes for the bleeding.  If the infection spreads from the bladder into the kidneys, the patient is much more ill and typically exhibits flank (kidney) pain, fever and chills.    If untreated, kidney infections may spread into the blood stream causing a life threatening disorder called septicemia.  This requires hospitalization, intravenous antibiotics and intensive care.

Most UTIs involve the lower urinary tract (urethra and/or bladder).  A tentative diagnosis is made by doing a urinalysis which typically demonstrates white blood cells (“pus cells”) and bacteria.  A positive dip stick test of the urine for nitrates or leukocyte esterase strongly suggests a UTI but culturing the urine for bacteria provides a definitive diagnosis.    Sensitivity studies are then done on the culture to determine which antibiotics will destroy the germ.  Most routine UTIs require 3-7 days of antibacterial therapy.  If the infections are frequent, long-term low dose daily or post-coital prophylactic antibacterial therapy may be needed.  In younger women, there is some evidence that cranberry products may prevent the recurrence of UTIs.  However, the dose is not standardized and they have not been successful in treating UTIs.   In the post-menopausal female, topical vaginal estrogen therapy may be of benefit.  Patients with recurrent UTIs often need to consult with a urologist to have their urinary system evaluated to try and find the reason for the frequent problems.  This usually involves imaging studies of the upper urinary tract, cystoscopic examination of the bladder and a measurement of residual urine (that urine still left in the bladder after urinating).    Good luck.

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Arthur Goldstein, M.D.

Expertise

Problems or questions related to the field of urology; ie urinary stone disease, urinary cancers (kidney, bladder, prostate, testis, etc.), urinary infections, etc. I no longer answer questions related to erection problems or male sexual dysfunction.

Experience

I am retired from the active practice of urology. My 34 years was totally in the clinical field and involved the entire gamut of genitourinary problems, with special interest in endourology.

Organizations
American Medical Association, American Urological Association, American College of Surgeons

Education/Credentials
College degree - BS Medical degree - MD Master of Science - MS

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