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Q. What could be causing this symptom of cloudy urine?

Answered by
Dr. Shahil Khant
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on May 12, 2018

Hello doctor,

I am a healthy 32 year old female with no past urologic complaints. Starting three months ago, I had some episodes of cloudy urine and I got a urinalysis and had 1 plus leukocyte esterase and occasional WBC and RBC. Urine culture came back with 100,000 colonies of Proteus. I took five days of Bactrim and within two months, it was back. I just finished a 10 day course of Cefuroxime 500 mg twice a day and got a repeat urinalysis two weeks after finishing antibiotics and again the same urinalysis with occasional WBC and 1 plus leukocyte esterase and 100,000 colonies of Proteus mirabilis. What could be causing this?

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Hello,

Welcome to icliniq.com.

Relax and do not worry. The length of female urethra is only 4 cm. So naturally, females are more prone to urinary tract infections (UTI) than males.

What are your symptoms at present? Do you have any urinary problems like a poor flow of urine, burning, etc.?

UTI usually occurs after sexual intercourse. You are suffering from recurrent UTI. If you are asymptomatic, I want you to confirm urine culture at a different lab (not the same lab where you did the last culture). I also want you to get done ultrasound abdomen with postvoid residual urine.

Meanwhile, continue cranberry extract. And follow proper hygiene techniques during washing of anal region after passing stools. Do not wash from back to forward, wash from forward to back so that it will not contaminate your periurethral region.

If you are asymptomatic, avoid antibiotics now. And get the above tests done.

For more information consult a urologist online --> https://www.icliniq.com/ask-a-doctor-online/urologist

Thank you doctor,

I have absolutely zero symptoms right now. The last episode of cloudy urine I experienced was one week ago and it only occurred because I had coffee and did not drink enough water. Before all of this started, I was chronically dehydrated. Ever since, I have been drinking massive amounts of water and that seems to clean up my urine. The only trigger now is caffeine without water supplementation. I am getting referred to a urologist and will try to get an appointment as soon as possible but I am just very worried because it seems like the antibiotics do not touch Proteus and I cannot figure out why. I have over 100,000 colonies right now and each time I get antibiotic susceptibilities done, it always shows susceptibility to the antibiotic that I take. I just do not know why I cannot clear it. Is it dangerous to not take antibiotics right now? Will I get pyelonephritis? Do you know why the bacteria do not respond to the antibiotics?

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Hello,

Welcome back to icliniq.com.

If antibiotics are sensitive to Proteus, there is no reason that it should not kill Proteus. There should be some reason for recurrent UTI. At present, there is no fever. So, no need to worry at all. No risk of pyelonephritis.

If you start getting fever than only start antibiotics. Meanwhile, arrange a consultation with your urologist.

For more information consult a urologist online --> https://www.icliniq.com/ask-a-doctor-online/urologist

Hi doctor,

Thank you so much. I have one more question for you. I did a repeat urinalysis the day after finishing my antibiotics after 10 days and it was completely clear, no leukocyte esterase or WBCs were present. Did that mean I actually cleared the infection at that point or was it a false negative because the antibiotics were only finished a day before? Because two weeks later, I was retested and the Proteus was back and I want to know if it was a reinfection or was it never cleared in the first place? I did have intercourse in the two week break before retesting the urine but I take all the right precautions and so I do not know what to do.

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Hello,

Welcome back to icliniq.com.

I think it is not a reinfection. It is because your previous infection was not cleared. Repeat urine test should be repeated minimum of three days after stopping antibiotics. So, I think it is false negative.

Anyhow it is a common problem. You may require a long course of antibiotics. Just get a physical examination done by your urologist.

For more information consult a urologist online --> https://www.icliniq.com/ask-a-doctor-online/urologist


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