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Dr. Vamvakias, Veterinarian
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Experience:  Small Animal & Emergency Medicine
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Persistent E. Coli Vaginitis in 12 yr old Golden Retriever

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I have a 12 yr old spade golden retriever diagnosed with E. Coli Vaginitis which has been unresponsive to 2 months of antibiotics (Orbax, Keflex). Vaginal scoping was normal (no WBC, inflammation or cancer cells). One week ago, began spotting fresh red blood, worse after urination. Ultrasound revealed a thickened bladder wall, normal uterine stump, no obvious nodules or tumors. Does this really sound like vaginitis or a urinary problem? Blood work (electrolytes, CBC) were normal. Dog is afebrile, playful and has a good appetite. Vet would like to start estrogen therapy for the vaginitis and possibly start choramphenical. I'm confused and obviously concerned about my dog. Does this treatment sound reasonable? Any other ideas or suggestions?
 

When was the last culture and sensitivity done on her and what were the antibiotic's that were listed?


 Did the vet give you an explanation on why he thought vaginitis vs. bladder issues?

Dr.V

HelloCustomer-What was the initial symptom and what tests were done initially that they came up with E. coli vaginitis? Culture/sensitivity or others? Dr. Jo
Customer: replied 11 years ago.
Vet. thinks this is vaginitis, not bladder related.   My concerns:
1. normal vaginal scoping
2. thickened bladder lining - radiologist told me this is either related to an infection or neoplasm.
3. bleeding is worse after urination

Customer: replied 11 years ago.
Reply to J. Leonard DVM's Post: Initial symptom was a milky green discharge from vulva. Culture revealed E. Coli which was sensitive to Keflex and Orbax. Vet told me it was vaginitis.
What made her think vaginitis, I have no idea. A urine culture was never done.    

 Well, in my opinion you do have reason to question when stating the 3 issues above.


Bleeding at the end of micturition(urinating) usually bladder related.   Did your vet have an answer for the thickening of the bladder? Is the radiologist consulting with your vet?

Dr.V

 

Customer: replied 11 years ago.
Reply to Dr. Vamvakias's Post: Vet told me that the bladder wall thickening is normal (although the radiologist told me otherwise). My vet consulted the radiologist for the ultrasound to rule out a uterine stump infection. Other than the radiologist faxing the ultrasound report to my vet, I don't think there has been any other contact.
Customer: replied 11 years ago.
Reply to ZooCVT's Post: Other than the initial culture two months ago, there has not been a repeat culture. I didn't actually see the sensitivity report, but the vet told me the E. Coli was sensitive to Keflex and Orbax.

I talked the vet into stopping the antibiotics and doing a urine culture on Monday, but she really doubts it is a UTI. Why? I don't know.

 I guess my final question is...currently what are the clinical signs?  Is there still purulent material? Or is it blood? How long has the dog been on antibiotics?

Dr.V



Customer: replied 11 years ago.
Reply to Dr. Vamvakias's Post: Purulent green milky discharge persists. Fresh red blood noted when she is wiped after urination. About a quarter-sized area of blood on dog bed each morning. Dog has been on antibiotics for 8 weeks.    Other than sleeping alot (she is 12), no other obvious signs of infection. She is afebrile, playful and has a good appetite.

Is it possible that this purulent drainage could be coming from her urethra and not the vagina? Just seems weird that the vaginal scoping was completely normal.

 Okay...here goes my opinion and I hope that Dr. Jo weighs in as well...because you may be able to get two vet opinions...which doesn't happen too often.


I think your vet has done a good job so far trying manage this case, unfortunately your dog is not turning out to be a "normal" vaginitis type dog. I will say studies suggest that primary bacterial vaginitis is not a "common" occurrence. Vaginitis is almost always a secondary issue to another problem.  My concern, as yours, is that something is being overlooked.  And 8 weeks with no repeat in culture and sensitivity when the symptoms remain is concerning as well.


The next steps I would take is first...a cystocentesis...this is pretty routine where urine is taken from the bladder prior to passing down the urethra and out.  This tells us...is there blood/bacteria/pus/fungus/cancer cells in the urine (bladder) before it heads out.  It there is, you need to address the problem there.  This urine is sterile in the catch so the urine also goes for a culture and sensitivity.  This would be by far the biggest diagnostic value.  You have to determine if the bladder is the underlying cause.  You most definately can have a problem and vaginitis /pus coming from the urethral tract. 


The other thing with vaginial treatments in my experience is that the infection is mixed...meaning bacterial and yeast...and treatment for the yeast is ignored.


Let me know what you think and post your comment and I hope Dr. Jo replys as well!

Dr.V

 

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Customer: replied 11 years ago.
Thank you!!! A cystocentesis is being done on Monday. But, I had to request the urine culture and I don't think my vet was too happy with me.

If the culture is negative, do you agree with estrogen treatments for the vaginitis? What about chloramphenical? I know this is a nasty antibiotic in humans ( I am an RN), but the vet said that dogs don't get the aplastic anemia like humans do.
HelloCustomer-Sorry, I got frozen out on my computer. I wanted to say that cystocentesis would be my next too. Best scenario--bladder infection with organism or organisms and sensitivity results with antibiotics of choice. Worse scenario--no growth due to such a long period of time of antibiotics. I would think about the radiologist thinking the bladder wall is too thick, and if you have a negative culture, and are still seeing blood, you may wish to consider a biopsy of the bladder. Is surgery, but better to know for sure. I am not crazy about estrogen, especially with uncertainty abounding. I also am wary of chloramphenicol. It is not allowed in food-producing animals with good reason. I still use it in exotics, but will only use it in pets if it is only choice by culture and sensitivity. thanks, XXXXX XXXXX
Customer: replied 11 years ago.
Thanks for your response. Antibiotics were stopped yesterday, so she will be off the drugs for 5 days before the cystocentesis.

Other than cancer, are there any other causes of a thickened bladder wall?
I have had no growths come back from the lab with only five days off antibiotics when I knew for sure there was a UTI), but this is a tough call. I would call the lab (or have your vet call) that will be doing the C/S and see what are their recommendations.

The big reason for thickened bladder wall are cystitis, bladder stones (not all are visible on xrays) and bladder tumor (which can be solid mass or intrusive within lining).

Good luck, and keep us posted. Dr. Jo
Customer: replied 11 years ago.
Thanks to everyone for your help. Your responses have been greatly appreciated and very helpful!

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