38,yr old lady is a diagnosed case of diabetes mellitus type 1,DCM &diabetes insipidus. She is under management for both and is well controlled. She has complaints of dysuria during her menstrual cycle accompanied with heavy bleeding P/V. I put her on a urine alkaliser and tab nitrofurantoin and ofloxacin post sending urine for R/E & C/S. urine r/e shows few epi cells and micro organisms but urine culture was negative even on repeated samples. What could be the diagnosis and management for her?

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negative urine culture,dysuria and menorrhagia during menses point towards endometriosis.p/s can, chic, and TVS for diagnosis. cystoscopy if needed. laproscopy is the gold standard .other causes can be vaginitis.antibiotic coverage as already started should be completed.COCs or progestins can be given.

Dr Nitrofurantoin acts in acid medium only, then how come have u added alkalizer along with?

acidic
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since you have already started ofloxacine . urine culture will be negative. complete antibiotics course at least for seven days. every thing will be alright. now a days doctor are also in a hurry along with patient. patient do not have patience but doctor should have. it may be viginitis or may be uti.

Rather than using such harsh words better read my words again. " I started antibiotics post sending urine sample for C/S...." It means.... sent the urine sample and then started the antibiotics while awaiting the results.
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Advised c & s of urine after stopping all antibiotics, then treat accordingly. Repeat blood sugar after then & conclude the diagnosis, don't hurry.

please note. .when using nitrofurantoin, urine shouldn't be alkaline

Thanks sir
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As she is having dysuria during menses time n having heavy bleeding so tell her about hygiene, changing of sanitary pads n prescribe some vaginal wash to make vaginal pH normal. Second thing give her trenexamic acid tab/Inj round the clock to control excessive bleeding. Advice her for plenty of fluids about 2 to 3 liters. Instruct her not to hold urine. Rest of the trt continue to control of her diabetes etc. Make final diagnosis by available modalities.

what is the pelvic USG findings Rule out vaginitis,

since she is having dysuria only during menstruation should rule out endometriosis

advice TVS for pelvic organs to detect endometriosis .

get her pelvic USG for any uterine pathology

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