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Dr. Y.
Dr. Y., Urologist
Category: Urology
Satisfied Customers: 20370
Experience:  Specializing in general urology and reconstructive urology.
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Dear Sir/Madam, Im 53 years old now (female). From last

Customer Question

Dear Sir/Madam,

I’m 53 years old now (female). From last October (2013/10), I began to have abnormal discharge from my vagina (yellow liquid) and pain feelings (vaginal burning, urethral orifice burning, frequent urination with pain, and swollen anus), and I was suggested to use some medicines, which includes miconazole nitrate suppositories, Nifurateland Nystatin Vaginal Suppositories and Clotrimazole Vaginal Tablets, I used them for 3 months. However, all of them are ineffective. After seeing another doctor, he suggested that this problem (abnormal discharge) might be caused by uterine lesions, and then I took an operation for a complete hysterectomy (includes cervical and ovary). Now it shows this operation is not necessary in terms of the treatment, and I’m still suffering from the discharge and pain feelings. A recent test shows a positive result of enterococcus faecalis, and the using of Chloramphenicol (washing liquor) is not effective. I am really suffering now, and could you please provide some suggestions in terms of the treatment and using of medicines. Does this problem have a relation with the Climacteric? Many thanks for your help!

Kind regards
Submitted: 2 years ago.
Category: Urology
Expert:  Dr. Y. replied 2 years ago.
Hello and thanks for trusting me to help you today. I look forward to working with you.

Where was the enterococcus infection detected? Was it the bladder? If not, have you had a urine culture done?
Customer: replied 2 years ago.


This infection was tested by the Peking Union Medical College Hospital, Beijing, China. The infection was found in my vagina. I didn't check the bladder. I did the urine culture for once, and didn't find enterococcus faecalis, shall I do another one?

Customer: replied 2 years ago.


Is the enterococcus faecalis infectious to others, such as my family. Thanks.

Expert:  Dr. Y. replied 2 years ago.
The enterococcus in the vagina may just be migration from the rectum since they are so close together. This is not infectious to others.

Your problems may very well be related to climacteric. Since your ovaries are gone, your estrogen levels are low and this can cause pH imbalances in the vagina. I would recommend that your doctor consider putting you on a course of topical vaginal estrogen cream to see if this helps to stop the symptoms.

They may also want to consider treating you for a possible vaginal infection called bacterial vaginosis. This is treated with a medication called metronidazole. Hope this helps.
Customer: replied 2 years ago.

Dear Dr. Y.,


Thanks for your reply.


 


I began to have the pain feelings with my vagina and urethra before I taking the operation, so I think even the pH level is balanced, I still feel poorly. My concern is that the enterococcus faecalis is the main reason of my problem, and as you suggested, I used the topical vaginal estrogen cream and metronidazole, but it seems that they are ineffective either. I did a little research on the internet, it says the enterococcus faecalis is difficult to be treated, do you have any suggestions of treating it? Are there any other tests that I should take?


 


Many thanks!

Expert:  Dr. Y. replied 2 years ago.
Nitrofurantoin is good at treating enterococcus, so your doctor may want to consider this. Other than that, there are really no other tests to be done to evaluate this (other than a good formal pelvic exam.
Customer: replied 2 years ago.

Dr Y.,


 


Thanks for your reply.


 


Are there any medicines that I can apply to my vagina to kill the enterococcus faecalis? As you mentioned pH level, there is a medicine produced by a German company named Eubiolac Verla - a lactobacillus tablet used within the vagina, would you consider using this kind of medicines for my problem? Do I need to take anoth urine culture?


 


Many thanks for your help!

Expert:  Dr. Y. replied 2 years ago.
No, there is no topical treatment for the enterococcus. You would shave to take an oral antibiotic like nitrofurantoin for this.

As you mentioned pH level, there is a medicine produced by a German company named Eubiolac Verla - a lactobacillus tablet used within the vagina, would you consider using this kind of medicines for my problem? - You can take this to see if it helps. It probably won't help, but it probably won't hurt either.

Do I need to take another urine culture?- Yes, I would recommend another urine culture to make sure you don't have a urine infection.
Customer: replied 2 years ago.

Dear Dr Y,


Thanks for your reply.


 


I understand that the enterococcus faecalis is hard to be 100% treated, and have you treated any other patients that have similar problem and be well treated. As you mentioned nitrofurantoin, and I was suggested to use Ampicillin as well, but for medicines like these, I am really worried about



drug-resistance, if this happened, it seems that my problem will never be treated.



Many thanks!


Expert:  Dr. Y. replied 2 years ago.
Yes. I have had to deal with enterococcus that is difficult to clear. Ampicillin is another good choice. You should not worry about antibiotic resistance in this situation because you have an actual infection that needs to be cleared. As long as you finish your course of antibiotics, you don't have to worry about antibiotic resistance. Hope this helps.
Customer: replied 2 years ago.

Dr Y,


 


Thanks for your reply.


 


I'm still a little worried about the antibiotic resistance, I mean what shall I do if I took the medicines, and before the enterococcus faecalis is 100% cleared, the medicines (such as Ampicillin) become ineffective? Because I heard that some patients got this kind of problem.


 


Many thanks!

Expert:  Dr. Y. replied 2 years ago.
There is nothing you can do about all the other antibiotics you took other than to complete the correct course of antibiotics to clear all the current bacteria out.

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