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A 37 year old pt presents with increased vaginal discharge,

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A 37 year old...

A 37 year old pt presents with increased vaginal discharge, white in color without odor, vaginal irritation, itching. She also presents with dysuria, hematuria, increased frequency, and burning during urination. Lower abd pain with flank pain. Pt was treated 7 days ago 250mg rocephin IM, 1g azithromycin, 150mg diflucan. 2days ago treated with 2g Flagyl. She continues to complain of urinary symptoms with vaginal irritation.

Doctor's Assistant: How long have you been dealing with the burning? Are you experiencing any other discomfort?

9-10 days

Doctor's Assistant: Anything else in your medical history you think the doctor should know?

Hysterectomy, increased stress

Submitted: 8 months ago.Category: Medical
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Answered in 2 hours by:
11/22/2017
Doctor: Dr. Muneeb Ali, Doctor replied 8 months ago
Dr. Muneeb Ali
Category: Medical
Satisfied Customers: 9,961
Experience: MBBS, MD, MCCM. Currently working in Critical Care Medicine with 10 year experience in Medicine
Verified
Hi,
Welcome to Ja and thanks for this question. I'm sorry to hear about your symptoms. I just came online to see that you have been waiting for some time. Now from what you are describing it sounds like that you are still suffering from an infection of the genitourinary tract. This would be diagnosed with the help of a repeat urine analysis, urine cultures, abdominal ultrasound. The ultrasound is extremely important here. This will tell us if the infection has tracked up into the kidneys or not. Given your vaginal discharge this sounds like a severe fungal infection which has not responded to fluconazole. Some fungal infections need a longer course of therapy with fluconazole, even upto 6 weeks or more intensive regimen with fluconazole used on an alternate day basis.
It is also possible that the fungus is resistant to fluconazole and you would need a special fungal culture to determine which anti fungal should be used in that case however generally speaking voriconazole should be tried when fluconazole fails.
The other possibility is that you have a bacterial infection which is resistant to the antibiotics used, again a culture would be needed to determine the ideal antibiotic. Sometimes you could have both a bacterial or fungal infection which cab be resistant and both could be worsening the situation.
I would recommend that you get additional testing done with special concentration on the possibility of resistant infections.
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Doctor: Dr. Muneeb Ali, Doctor replied 7 months ago

Would you like to know anything else? Any clarifications or additional questions that you might have, i would be happy to answer them for you. If done for now, please remember to leave a positive rating as that is the only way we are compensated for our time spent helping you. You can continue to ask follow-up questions even after the rating. Any BONUSES would be well appreciated!

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