“I took antibiotics for UTI but symptoms are still there”, it’s a common complaint among chronic UTI sufferers but it could mean a lot of different things. I asked Dr. Lisa Hawes a urologist at Chesapeake Urology to help to navigate different case scenarios and discuss what they could potentially mean. Do not diagnose yourself, and definitely, do not attempt to treat yourself based on this information only.
This post should rather serve you as a guide for a conversation with your doctor. When you know what to mention during your doctor visit, you have higher chances to get better care.
Option #1: Bacterial Antibiotic Resistance
Have you taken all prescribed antibiotics but your symptoms are only getting worse? It could be that your bacteria are resistant to this type of antibiotics.
You might have heard about superbug bacteria that withstand all available antibiotics. Well, increasingly, bacterial resistance is a real-life problem that physicians facing more often than before.
Here are main signs that could signal that your bacteria are resistant to the prescribed medication:
- You are feeling worse, while you’ve been taking antibiotics diligently for over 48 hours
- You are experiencing fever or nausea (must see a physician right away).
“Realistically, you should feel much better by the third day of an antibiotic treatment, bacterial load should be lowered, and therefore symptoms should subside”, says Dr. Lisa Hawes “even if not all symptoms resolved, you definitely should not have cloudiness, odor, or blood in your urine 48 hours after starting antibiotics”.
Signs that UTI is not responding to antibiotics
What if you feel lower back pain? Is this a sure sign that infection is progressing to the kidneys and antibiotics are not working?
“While lower back pain could be an important sign of kidney infection, in many cases low back pain alone is not a sure sign that bacteria ascended to the kidneys, it could be just pain radiating from the bladder due to UTI,” clarifies Dr. Hawes. However, if you are experiencing fever (102 -103 F) and/or nausea, these are very serious symptoms and you should seek immediate medical attention.
This is when the chances are higher to get sick with an infection caused by antibiotic-resistant bacteria:
- You underwent multiple UTI treatments in your lifetime
- If you have been using the same antibiotic for previous infections
- Stopped taking antibiotics and didn’t finish all pills that your doctor prescribed you
- If you are guilty of keeping a stash of antibiotics and self-treating UTIs, cold, travel diarrhea etc.
- You’ve been recently hospitalized
- If you are immunosuppressed or have any serious chronic health issues, for example, uncontrolled diabetes.
Dr. Hawes highlights that it is important to request a urine culture test before deciding on a type of antibiotics. If you are taking multiple antibiotics without checking bacterial drug sensitivity, it’s a guessing game that only increases your chances to develop a resistant bacteria.
In my Actionable Guide for UTI, I explain how to increase the effectiveness of antibiotics and discuss treatment and tests with your physician.
Option #2: You Took Antibiotics For UTI But Symptoms Still Linger? Maybe It’s Not A UTI
Unfortunately, this scenario happens way too often: you have had many well-diagnosed UTIs in the past, so when you complained of UTI-like symptoms, your doctor prescribed you antibiotics right away.
Sometimes, after you take antibiotics you could even feel better but then you notice that some symptoms (urgency or bladder pain) still remained. This could be confusing, especially if antibiotics did bring you a slight relief.
Per Dr. Hawes, if you never had blood in your urine, cloudy urine or funny smelling urine in the first place, if your only symptoms were bladder pain and slight burning with urination, then chances are high that it was not a UTI.
As Dr. Lisa Hawes explains ”After multiple UTIs the bladder lining is damaged and inflamed. When the protective GAG bladder layer is damaged, the acidic urine can easily irritate the bladder and cause pain”.
If you noticed that drinking lots of water help with your condition, it is because you are simply diluting the urine and making it less irritating to your bladder walls.
Medications and supplements that help to coat the lining of the bladder (similar to how Pepto Bismol can protect stomach lining) could greatly reduce these symptoms.
Took antibiotics, some UTI symptoms resolved, other symptoms still linger
So why if it wasn’t a UTI, the prescribed antibiotics worked and you did feel a relief? Well, there could be at least three reasons:
- It could be that you are lucky to experience the famous placebo effect. It means that your body healed itself when you are given an irrelevant medication or even a sugar pill. This phenomenon affects up to 75% of patients in controlled groups (depending on a disease) and while it is still not well understood, it’s a real thing.
- Another option is a test failure. No tests are 100% accurate. There is always a room for human error, too. So it could be that there was, indeed, an infection in your sample but the lab wasn’t able to culture it. The chances for a mistake are higher when urine is too diluted with water that you were drinking excessively prior to the urine test. It could also be that a certain type of bacteria is more irritating to the bladder even with a lower count.
- Moreover, Dr. Hawes encountered many patients in her practice that claim that specifically, Cipro helps them with their UTI-like symptoms even when a lab finds no bacteria in their urine.
Dr. Hawes hypothesizes that it could be due to some sort of a side-effect from Cipro: perhaps, the medicine does something else to the body besides killing bacteria that could indeed reduce UTI-like symptoms.
Bacteria in my poop could...
Why Your UTI Test May Be Negative Even When You Have Symptoms
How about the study that looked at bacterial DNA in the urine of women with UTI-like symptoms who also had a negative culture test?
To summarize, the researchers looked at urine samples of women without symptoms and a group with UTI-like symptoms. They performed two tests: a culture test and a DNA-sequencing test that allows identifying if there is any bacterial DNA in urine.
According to the study, 90.5% of symptomatic women with a negative urine culture tested positive for Escherichia coli bacteria with molecular methods compared to about 5.3% of women without symptoms.
This allowed the researchers to conclude that culture tests might not be sufficiently accurate and if a patient complains of urinary tract infection symptoms, she might as well be treated for an acute UTI.
The findings are gaining traction among chronic UTI sufferers who feel that the study finally gives more credibility to their complaints.
“However”, argues Dr. Hawes “the significance of finding bacterial DNA may be different than the significance of finding live growing bacteria. Does the DNA stay around after an infection? If so, for how long? How do you determine antibiotic sensitivity based on DNA findings rather than live growth?”.
If you’ve seen any criminal movies in which the action is taking place after the mid-80s, you expect that police will do a DNA test to confirm who was at the crime scene. However, there is a difference between establishing that a suspect was at the crime scene at some point in time versus finding out where is the suspect now.
As Dr. Hawes concludes, “We don’t yet understand the clinical significance of this data”. In other words, do not dismiss the results of your culture test because of this study.
Discuss with your doctor if some of your UTI symptoms persist after antibiotics
Here are several questions that you should think about prior to your doctor visit to help your physician with the right information:
- Are your symptoms stronger when the bladder is full and you feel better after urination?
- Does a certain position (sitting versus standing) trigger bladder pain?
- Do you feel that your symptoms stay the same over the course of days and even weeks?
- Is there blood in your urine, foul smell, or is your urine cloudy?
- If you’d like more help on how to discuss your UTI with your provider and how to make the most out of your patient-doctor relationships, check out my Actionable Guide here.
Option #3: Persistent UTI Symptoms After Treatment
Here is another option: they sent your urine sample to a lab and later told you that according to the test you have a UTI. However, antibiotics resolved some symptoms (such as blood in urine), but urge to urinate or pain in lower abdomen remained.
As you could imagine, there could be a scenario when not only you have a full blown UTI, but also an inflamed bladder lining is causing additional symptoms, as discussed above.
In this case, you, most likely, will see a reduction in pain, and your urine will become clear. However, pain in the bladder area and slight irritation after urination might still linger.
Moreover, when patients mention they feel burning in the urethra rather than the bladder, it’s quite normal. In fact, the urethra has more nerve endings that could be easily irritated due to underlying inflammation.
Option #4: UTI Symptoms Return After Antibiotics?
Another story is when your urine test did show a UTI. You then took antibiotics, felt completely fine, but several days later woke up with the same nasty UTI symptoms.
“Here two options are possible: we were unable to eliminate the infection completely or it is a reinfection”, says Dr. Hawes “if only 2-3 days elapsed since treatment and symptoms recurred, most likely we were not able to clear the infection. However, if you get an infection 2-3 weeks after your last antibiotic treatment, count it as a reinfection”.
Bacteria hide in your bladder lining
One interesting fact from Dr. Hawes: during bladder cystoscopy of chronic UTI patients she frequently sees “pimples” on their bladder surface. The correct medical term is Cystitis cystica, which is a benign lesion of the bladder as a result of a chronic inflammation.
These “pimples” are “thought to be caused by chronic irritation of the urothelium because of infection, calculi, obstruction, or tumor”.
Per Dr. Hawes, a biopsy of these pimples typically comes back with results of bacterial contamination. Basically, bacteria comfortably reside inside of these “pimples” on a bladder wall. The worst thing, they can reappear from time to time to cause yet another infection. That’s why you notice that UTI symptoms come back after antibiotics.
If that’s the case, Dr. Hawes’ identifies the type of bacteria via a culture test and which antibiotic bacteria are susceptive to. After that, she combines a short-term intensive antibiotic therapy with a long-term (1-3 month) low dose antibiotics. This normally kills bacteria that keep reappearing out of the cysts into your bladder.
Many thanks to Dr. Lisa Hawes who took time of her weekend to share these insights. We hope this information will help you when discussing a treatment plan with your urologist. And if you are happened to be in Maryland, here is contact information for Dr. Hawes’ practice.
What Else Can You Do When Antibiotics Fail?
When it comes to the best treatment for recurrent chronic UTIs there are two main camps.
Some physicians prefer a long-term antibiotic treatment protocol, frequently prescribing a variety of antibiotics over the course of several months (or even years).
Others advocate for the mindful use of antibiotics and focus on correcting underlying dysbiosis as the main reason for recurrent UTIs. In fact, we are still learning about human microbiome and the effect bacteria have on our health and it seems less and less probable that antibiotics alone could solve chronic issues.
Moreover, antibiotics were developed when we thought that a healthy bladder is sterile which we know is far from the truth.
What is the best approach to cure a chronic UTI? Here is a selection of posts that can help you to get up to speed:
- A holistic approach to UTI treatment
- Best UTI treatment is systemic
- Bacterial biofilms in chronic UTIs.