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Unusual urine odor
Urine odor is usually not because of urinary tract infection. It is often due to:
1) Concentration (ammonia smell)
2) From foods we've eaten
3) From the sweat glands of the perineum
4) From vaginal bacteria
See also our article on perineal body odor You may want to avoid pungent vegetables like onions, garlic, asparagus and fatty meats for several days and see if the urine odor changes.
Urine culture
Broth cultures are sometimes used to grow out bacteria that are difficult to grow. "Broth" just refers to a nutrient mixture made up to grow a particular organism or group of organisms. The expense of the culture should not be more than any other type of culture. It depends on your local lab. This isn't a new technique. I'm not really aware of how often the microbiology lab uses a broth culture; we just send culture swabs and expect the lab to use the best culture for the clinical situation.
Without pain it is unlikely that you have interstitial cystitis. The nurse practitioner may be using the broth culture to check for unusual urethral organisms such as ureaplasma or mycoplasma.
Enterococcus urinary tract infection
Enterococcus is a streptococcus bacteria called Group D streptococcus that is normally found only in the gastrointestinal (GI) tract. It is a somewhat frequent cause of urinary tract infections and probably gets from the rectal area into the urethra from sexual intercourse or wiping the rectum in the wrong direction toward the vagina. Thus it is a normal bacteria for your body, it just got in the wrong place. The most common cause of urinary tract infections is E. Coli which is another bacteria normally found in the GI tract.
After you are treated with antibiotics for the enterococcus, you might try to prevent repeat infections by drinking cranberry juice. This has been shown to be bactericidal against E. Coli but I do not think it has been tested against enterococcus. It would not hurt though.
Persistent symptoms after treatment
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It sounds as if the pressure and feeling of need to urinate started with the urinary tract infection. It may be just a residual from that or perhaps you had some vaginal/pelvic infection at the same time. Be sure your doctor does a culture for sexually transmitted diseases (STDs).
The acne is unrelated, the back pain may or may not be.
Options would be:
1) see urologist to look for other urological problems such as urethral syndrome (but you would have some burning urination) or interstitial cystitis (you would have a lot of urinary frequency) or perhaps a chronic bladder infection (except your culture was negative).
2) Have empirical treatment with another course of antibiotics in case the infection is not quite cleared.
3) If tolerable, do nothing unless the symptoms get worse or fail to resolve over another 4 weeks, and in either case you need to return to your doctor.
Burning on urination
The burning may be from the period but it depends on where the burning is. If it burns as the urine hits the outside, it is probably just related to the menses. If she were to sit in a bath tube and void and there was no burning, that would confirm it. If there is burning with voiding in a tub, then it is internal in the urethra and she needs to be treated.
It is very difficult to get a culture while one menses without a catheterization. If she has symptoms of internal dysuria, most offices will go ahead and treat with antibiotics unless she has some chronic problem that needs more certainty in diagnosis.
Streptococcus infection
Streptococcus infections of the vagina or even urinary tract are less common than other types of infections such as E.coli in the urinary tract, or bacterial (a mixture) vaginosis in the vagina, but they certainly occur. Streptococcus bacteria is usually picked up on the skin from the outside but one type of streptococcus, group D enterococcus, is commonly found in the GI tract.
This GI enterococcus would be much less common in a pediatric patient than an adult, but if she is having chronic problems of some type such as bowel problems, then strep might be more likely to occur to a young girl.
Bleeding after urinary tract infection
I cannot give you advice that will keep you away from the doctor. You have to have your blood count checked as soon as possible because of the amount of bleeding. Hormone therapy may be used to stop or slow down the vaginal bleeding but the most worrisome is the rectal bleeding. It still may be related to hemorrhoids even though you had and exam shortly ago. I would suggest getting bock to your doctor to let him know and at least get your blood count checked. He may be willing to prescribe hormones and recheck the rectum or he may want to refer you.
You may need a sigmoid to look at the rectum and colon. The uterine bleeding will also need some work-up unless it goes away with one or two cycles of hormone suppression. The doctor may want to do a pelvic ultrasound but if your exam is normal, that could be put off until the rectum and colon are evaluated.
Persistent symptoms after treatment
Most of the time antibiotics clear up an infection but not always. This second course may help. An alternative explanation to the pain is muscle or ligament or bony damage or swelling without infection. Perhaps an MRI could help determine this. This is an instance where the doctor's exam and knowledge of what went on at delivery will be the primary factors in determining what studies or treatment to do next.
Strep viridans infection
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Strep viridans is usually from the respiratory tract. It is unusual in the urinary tract although it can occur, possibly by blood borne sepsis from lung infection (pneumonia) or heart valve or heart infections such as (endocarditis). Your friend should be checked for these serious infections. Another source of this bacteria in the urinary tract could be from oral-genital sexual relations.
I'm not aware of bacteria in different layers of the bladder but some bacteria may be resistant or nonsusceptible to the antibiotics being used or the patient becomes reinfected after treatment because the source of infection is not eliminated or with a new bacteria.
Different bacteria
These broad classes of bacteria can be almost any bacteria, over 20 different species. The next report will categorize the specific bacteria. The most common gram positive cocci is streptococcus and the most common gram negative bacilli in the urinary tract is E. Coli.
An antibiotic like amoxicillin should cover both of those but you will need to wait to see what the specific bacilli are.
Some bacteria, such as E. Coli, are commonly found in the gastrointestinal tract and are carried from the rectal area to the urethral area by sexual intercourse or wiping the wrong way particularly after a bowel movement (you should always wipe from front to back).
10 days.
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