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Family Medicine (Expert Forum)
Indeterminate pelvic issue and clear urine
Answered by
Kevin Pho, MD - Internal Medicine
Kevin, M.D.
Boston - MA
Questions in the Family Medicine forum are answered by Dr. J.M. Keyes. Topics covered include general health issues, adolescence, babies, child health, eating disorders, fitness, immunizations and vaccines, infectious diseases, medical tests and procedures, and senior health.
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Indeterminate pelvic issue and clear urine
by isadoraduncan, Nov 29, 2005 12:00AM
I am a 34 y/o female who is generally in good health, eats well, is not sexually active, never taken the Pill, doesn’t smoke, and rarely drinks.
Four weeks ago, I went to the doctor complaining of a constant dull pain in my uterus and a low-grade fever. Also, the odor down there was pungent and different from the normal odor. Because of the pain I experienced during the exam, I was diagnosed with pelvic inflammatory disease (PID) and was given both Levaquin (500mg 1x/day) and Metronidazole (aka Flagyl, 500mg 2x/day) to take for two weeks. PID was a default diagnosis as I tested negative for yeast; I also tested negative for STDs, including Chlamydia and Gonorrhea, which are commonly the source of PID. I have never used an IUD nor have I ever douched. I am also HIV negative. The source of the PID, if that’s what it was, is still a mystery.
Three days before I was to finish the antibiotics, I experienced severe irritation around the vaginal opening. The doctor told me that they looked like herpes legions, and I was given Acyclovir (400mg 3x/day). I tested negative for HSV 2. The culture taken also tested negative for HSV 1, but blood work revealed that I had been exposed to HSV 1 at some point in my life.
As I took the Acyclovir in addition to the antibiotics, I noticed that my urine had become darker. Because this worried me, I was advised to stop all medications, and I did after two days of the Acyclovir. The legions disappeared on their own, returned, then disappeared again. Since stopping the three drugs, my urine has been uncharacteristically clear. There is a very, very slight yellow tint to it, but nothing like it was before. I am not hydrating any more than I normally have been.
I have been feeling fine otherwise with the exception of a scratchy throat, but I am very concerned about the clear urine. Is my body not getting rid of toxins? Should I be concerned about possible renal or liver failure due to the drugs? Or is this simply an issue of digestion and needing to rebuild the bacteria that helps digestion? The antibiotics gave me diarrhea, which has been getting better since I started taking acidophilus.
Also, why was the urine darkened to begin with? What was the cause of the legions? And do you think this was truly PID, or was it something else?
In addition, I still feel a some mild pain in the left groin area behind the pubic bone, a bit above it, and in the left labia majora. The doctor did not detect any lumps or anything out of the ordinary and isn’t worried, but I am. What could this be? Should I request more tests?
Four weeks ago, I went to the doctor complaining of a constant dull pain in my uterus and a low-grade fever. Also, the odor down there was pungent and different from the normal odor. Because of the pain I experienced during the exam, I was diagnosed with pelvic inflammatory disease (PID) and was given both Levaquin (500mg 1x/day) and Metronidazole (aka Flagyl, 500mg 2x/day) to take for two weeks. PID was a default diagnosis as I tested negative for yeast; I also tested negative for STDs, including Chlamydia and Gonorrhea, which are commonly the source of PID. I have never used an IUD nor have I ever douched. I am also HIV negative. The source of the PID, if that’s what it was, is still a mystery.
Three days before I was to finish the antibiotics, I experienced severe irritation around the vaginal opening. The doctor told me that they looked like herpes legions, and I was given Acyclovir (400mg 3x/day). I tested negative for HSV 2. The culture taken also tested negative for HSV 1, but blood work revealed that I had been exposed to HSV 1 at some point in my life.
As I took the Acyclovir in addition to the antibiotics, I noticed that my urine had become darker. Because this worried me, I was advised to stop all medications, and I did after two days of the Acyclovir. The legions disappeared on their own, returned, then disappeared again. Since stopping the three drugs, my urine has been uncharacteristically clear. There is a very, very slight yellow tint to it, but nothing like it was before. I am not hydrating any more than I normally have been.
I have been feeling fine otherwise with the exception of a scratchy throat, but I am very concerned about the clear urine. Is my body not getting rid of toxins? Should I be concerned about possible renal or liver failure due to the drugs? Or is this simply an issue of digestion and needing to rebuild the bacteria that helps digestion? The antibiotics gave me diarrhea, which has been getting better since I started taking acidophilus.
Also, why was the urine darkened to begin with? What was the cause of the legions? And do you think this was truly PID, or was it something else?
In addition, I still feel a some mild pain in the left groin area behind the pubic bone, a bit above it, and in the left labia majora. The doctor did not detect any lumps or anything out of the ordinary and isn’t worried, but I am. What could this be? Should I request more tests?
Doctor's Answer
by Kevin Pho, MD, Nov 30, 2005 12:00AM
, Nov 30, 2005 12:00AM
It is difficult to answer your questions without examination.
PID is certainly possible - any the antibiotics are appropriate for this diagnosis.
There is the possibility of a pelvic abscesses - and a CT scan can be considered to evaluate this possibility.
Dark urine can be due to infection, dehydration or kidney disease. Levaquin can be harmful to the kidneys in the setting of pre-existing disease, so you may want to consider blood tests to evaluate the creatinine level. Blood tests can also evaluate the liver function.
As for the lesions - the blood tests are not 100% accurate for herpes. You can send off a culture for a more definitive diagnosis.
At this time, a pelvic CT scan would not be unreasonable.
You can discuss this with your personal physician.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_b
PID is certainly possible - any the antibiotics are appropriate for this diagnosis.
There is the possibility of a pelvic abscesses - and a CT scan can be considered to evaluate this possibility.
Dark urine can be due to infection, dehydration or kidney disease. Levaquin can be harmful to the kidneys in the setting of pre-existing disease, so you may want to consider blood tests to evaluate the creatinine level. Blood tests can also evaluate the liver function.
As for the lesions - the blood tests are not 100% accurate for herpes. You can send off a culture for a more definitive diagnosis.
At this time, a pelvic CT scan would not be unreasonable.
You can discuss this with your personal physician.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_b
The heavy antibiotics suppressed my immune system to such a degree that the herpes (HSV 1) legions appeared. The immune system normally keeps the dormant HSV virus in check.
The meds also killed all my beneficial bacteria to such a degree that candida albicans (yeast) grew wildly in my intestines. Beneficial bacteria also keeps normally occurring candida in check.
Clear urine is a result of a lack of vitamin B-producing bacteria in the intestines. I'm replenishing these now by doing a colon cleanse and using probiotics. And never will I take antibiotics again.