Differential Diagnosis Part 1 (Or how I ended up on over 30 days of antibiotics)

In my experience, “getting sick” in my urogenital system wasn’t all that different from getting sick with a cold. It came on slowly, over the course of several weeks, just slow enough that I wasn’t totally sure if I was having symptoms or just a normal and fleeting bout of funkiness. Similar to waking up with a sore throat, I wasn’t sure if I just had some morning post-nasal drip or if I was getting the equivalent of the urogenital flu. Here I wanted to detail a play by play of the symptoms I had, and some of the more reliable websites that came up with my extensive google searching. This is not meant to be a tool by which to self-diagnose, but if these symptoms are sounding familiar to you, it may be a clue that a doctor can help.

It may be helpful to note as well, that sometimes one symptom (example: itchiness) can mean several things – it could be totally normal, but it could also be a symptom of a yeast infection, of BV, or of an STI like Gonhorrea. In medicine the process of figuring out what’s wrong with someone is called differential diagnosis, and it involves taking all of a patient’s symptoms and their history into account. The goal is to limit the pool of possible causes for the problem from a nearly infinite number to a much smaller number of possible options, and then testing can be done to rule in or rule out the provisional diagnoses – or the most likely culprits.

Finally, if you aren’t interested in differential diagnosis of the female urogenital system, or are squeamish to conversation about bodily functions and secretions – feel free to skip this post entirely. You can get a quick run-down on my medical history here, which will give you all the context you might desire.

Early November 2016

Pelvic Pain

The first symptom I noticed was pelvic discomfort, and just feeling a little off when I woke up in the morning. By mid-afternoon I was uncomfortable while sitting, and constantly feeling like I was on the edge of peeing my pants. By evening, I was crying in pain, peeing tiny amounts while still feeling like I had to go, and had blood in my urine. Urgent care took me, took one look at my urine, knocked on my back to make sure it hadn’t traveled to my kidneys and sent me on my way with antibiotics for a urinary tract infection. I was feeling better by the next day and felt fully normal in three days.

 UTI symptoms mayo clinic 1

Late November – Thanksgiving

Vaginal Itching

I came down with a disgusting cough that I ignored because I was in the middle of exams and thought I could use my cardiopulmonary curriculum to clear my secretions and recognize if there were something really wrong. Since it wasn’t my urogenital system coughing, I’ll spare you the details, but spoiler alert: I didn’t know enough to recognize that I had a bout of walking pneumonia, most likely from ignoring bronchitis for so long. I was on 10 days of antibiotics for the pneumonia.
When I think of antibiotics and itchy vaginas, I think of yeast infections, so when I started feeling a little uncomfortable after the completion of my meds for pneumonia, I kept an eye on my symptoms and looked for thick white discharge. I had discharge, and there was more of it than usual, but it was clear, and while I wouldn’t describe it as fishy, it was not my typical eau de genitalia. Since it didn’t fit my previous experience with yeast, I bought some over the counter extra strength vagisil for some relief and made an appointment. The appointment was quick – vaginal swab, looked at under a microscope. My PCP told me that it looked like BV and she didn’t see any yeast, but that there was an increase in white blood cells (WBCs). Under the microscope, she said, trichomoniasis (a sexually transmitted infection) can look like WBCs, but to tell for sure she would have to send off a culture. Based on my history of a monogamous relationship for the better part of a decade, she didn’t send the culture, but urged me to talk to my partner and to give her a call if my symptoms didn’t resolve. The other reason she didn’t immediately send off a culture was because I have an intrauterine device (IUD), which causes local inflammatory responses at the cervix, which could also explain my high WBC count. My doctor wasn’t excited about giving me more antibiotics given the long run that I had just been on, but that’s the treatment for BV, so she told me to lay off the wine, take the pills until they were gone, drink lots of water, eat yogurt, and take a probiotic for the inevitable intestinal storm that was headed my way.

web md 4

Vaginal Itching Link

web md vaginal yeast infection 2

Yeast Infection Link

cdc BV 3

BV Link

Mid December

I felt better for about a week and a half after I finished the medicine for BV, which gave me enough time to get through my 26th birthday celebration/ the beginning of the end of being on my parents’ insurance plan, and my final exams. I started feeling funky again about 3 days before I was leaving on a trip to Arizona to start my spring break. I say funky because my symptoms were kind of intermittent, and didn’t fit neatly into any of the boxes I have posted above. I couldn’t even really tell if it was coming from my vagina or from my urethra/bladder, and there were some symptoms that could have been coming from neither. Most obvious and annoying to me was that I felt like I had to urinate all the time, and it was worst immediately after I had just peed. You know that feeling of great relief you get after finally getting a good pee in after holding it for too long? It never came for me. I would pee, wipe, stand up, and oftentimes sit back down again to try for round two. I was uncomfortable, but couldn’t differentiate whether it was my vagina or my urethra. I took to wrapping a bag of ice in paper towels and sticking it in my leggings while I was at home. I also had some very low abdominal pain – like cramps I commonly associated with getting my period; possibly the most confusing since even though I have gotten cramps since my IUD was inserted, I haven’t had a period since 2014. I couldn’t tell if the cramps were even related. Because I was traveling for vacation and unable to see my PCP, I ended up in urgent care the day before my flight. I gave the doctor there a rundown of my symptoms, and he asked me if I had discharge – I didn’t at that point. He told me I didn’t need a pelvic exam, gave me the same meds for a UTI and sent me on my way.

The difference this time was that the meds for UTI didn’t help me right away- when I had a UTI in November those red pills that turned my pee orange were like a magic spell for my discomfort. This time, while my pee was just as orange, the pain didn’t dissolve. After a few days on the antibiotics, I did start to feel less uncomfortable, although I did still have to pee all the time, and I noticed that my pee was looking cloudy, like there were white flakes in it. To be honest, I can’t say I spent a lot of time looking at my pee before, so I thought maybe it had always looked like that, or that the antibiotics were causing it to happen. I filed it away in my head and enjoyed my vacation, ignoring all of my emails and calls, including a voicemail from the urgent care that said the culture of my urine came back negative for UTI.

Dun dun duuuuuunnnn

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