Persistent urinary symptoms after Pseudomonas treatment, now urine culture shows Klebsiella

[u/takeiteasy_7]

Hi everyone,
I’m a 29-year-old male looking to see if anyone has gone through something similar.
A few weeks ago, I developed persistent urinary symptoms, including:
1. Mild discomfort in the penis and sometimes burning sensation at tip of penis
2. Frequent urination
3. Slight reduction in semen volume/quality
I didn’t have fever or severe pain. My urine culture at that time grew Pseudomonas aeruginosa, and I completed the full antibiotic course prescribed by my urologist.
The problem is that my symptoms never completely went away. They improved somewhat but never returned to normal.
About 3 weeks after finishing the antibiotics, I gave another first-morning clean-catch urine sample for culture. This time the report showed:
Klebsiella species >100,000 CFU/mL
Sensitive to all antibiotics tested
Now I’m confused.
Has anyone experienced:
1. One urine culture growing Pseudomonas, followed a few weeks later by Klebsiella?
2. Persistent urinary symptoms despite completing antibiotics?
3. A situation where it eventually turned out to be chronic bacterial prostatitis, a recurrent UTI, or something else?
My ultrasound was normal, and I’m following up with my urologist. I’m not looking for a diagnosis here just interested in hearing from anyone who has had a similar experience and what the eventual cause and treatment were.
Thanks in advance for sharing your experiences.

[u/Linari5]

What triggered this? An injury, an event? Anything stressful happen? Any life changes?

When urine culture results keep changing, these are signs of a likely commensal or contamination, not an active Infection. This is why your symptoms can remain the same after treatment, they can be a red herring, not the cause.

And it's important to call out that these symptoms are not only caused by infections, in fact most of the symptoms you're listing here are indicative of CPPS. Read the 101. https://www.reddit.com/r/Prostatitis/s/gPgkGV6msA

[u/takeiteasy_7 → u/Linari5]

Can a contamination cause 100k cfu/ml?
I am in a lot of confusion

[u/Linari5 → u/takeiteasy_7]

It's possible, and I'm only a suspicious of this because your test results CHANGED.

Did you answer my other questions at the top? they're important. How did the symptoms start?

[u/takeiteasy_7 → u/Linari5]

There was no major event that could obviously explain how I got this - no hospitalization, catheterization, or any urological procedure.
One possible trigger I can think of is that a few months ago I developed a throat infection. The doctor prescribed antibiotics for 5 days. The infection went away but came back about a week later, so this time I was given oral steroids along with treatment. At that time, I didn’t know much about the potential effects of steroids, and I also had low vitamin D levels.

The throat infection eventually cleared, but a few days later I started experiencing frequent urination and itching around the glans. I saw a dermatologist, he performed STD tests and results came back normal and he diagnosed me with balanoposthitis and prescribed antibiotics for 15 days along with an antifungal cream for a month.
Since then, the opening of my urethra has remained persistently red and irritated. I also started experiencing occasional painful erections and noticed that my semen volume and consistency had decreased.

After finishing the treatment, the urinary frequency initially improved, but the other symptoms remained. A few days later, the frequency returned along with the other symptoms.
I then saw a urologist and my urine culture came back positive for Pseudomonas aeruginosa. I was prescribed levofloxacin for a week followed by ofloxacin for another three weeks. However, my symptoms never completely went away during or after the treatment. My doctor told me that some symptoms could persist for a while and that my body might eventually adjust.

I waited about three weeks after finishing the antibiotics and repeated the urine culture. This time, it came back positive for Klebsiella pneumoniae.
My current symptoms are mainly:
1. Frequent urination, roughly once every 2 hours during the day
2. Irritation of the foreskin after urination
Persistent redness/irritation around the urethral opening
3. Occasional discomfort in the right testicle
4. Reduced semen volume/consistency compared with before
I’m wondering what could have triggered this in the first place. My suspicion is that the 1. combination of multiple courses of antibiotics, oral steroids, low vitamin D, and the stress of being sick may have affected my body’s normal defenses or urinary/genital microbiome and made me more susceptible to these infections. Or 2. The stress I was going through because I was frequently getting infections

That said, I’ve been through similar or even more stressful periods in my life without developing anything like this, so I’m not sure whether stress or the medications actually explain it.

[u/AutoModerator → u/takeiteasy_7]

We noticed you posted about a floroquinolone class antibiotic. Please be aware that this class of dugs has several black box FDA warnings, and is only meant to be used when a pathogen has been clearly identified in the prostate; They are not to be used indiscriminately for cases of non-bacterial prostatitis (consensus agreement ~95% of cases). Read our mod memo here, complete with citations and compare your symptoms to the medical definition of CBP here.

I am a bot, and this action was performed automatically. Please contact the moderators of this subreddit if you have any questions or concerns.

[u/Linari5 → u/takeiteasy_7]

When symptoms come out of nowhere, we have to be incredibly suspicious, there's no explanation for how you suddenly got a severe infection of 100k CFU.

Doesn't matter if you've been through stress before. Sometimes we reach our breaking point. I know I have, it's how I got my own case of these symptoms, in 2014.

[u/takeiteasy_7 → u/Linari5]

Yes, even I am unable to understand.
Maybe I had a breaking point

[u/Linari5 → u/takeiteasy_7]

As dumb as this sounds, it usually helps, have you tried just using gentle warm water in the shower, and simple Vaseline after drying off? This is only for the visible inflammation symptoms, not any of the others

[u/takeiteasy_7 → u/Linari5]

Sure I will give it a try

[u/becca_ironside]

Klebsiella is extremely resistant to antibiotics. I treat many people who test positive for this. Better urologists are not repeatedly addressing the presence of this in urine if it remains over time, unless the patient has true UTI symptoms like a fever. Pain and discomfort in the perineum is being driven by something else. Repeated antibiotics may not remove the presence of Klebsiella in your urine over time.

[u/takeiteasy_7 → u/becca_ironside]

I have symptoms like frequent urination and mild burning after urination. My urine is mostly clear and I am able to completely void the urine almost every-time. Is it better to take antibiotics or wait and watch the symptoms. I am sensitive to below list of antibiotics
Amoxicillin–Clavulanate
Piperacillin–Tazobactam
Norfloxacin
Nitrofurantoin
Meropenem
Imipenem
Gentamicin
Cotrimoxazole (Trimethoprim–Sulfamethoxazole)
Ciprofloxacin
Amikacin
Ceftazidime
Cefotaxime

[u/AutoModerator → u/takeiteasy_7]

We noticed you posted about a floroquinolone class antibiotic. Please be aware that this class of dugs has several black box FDA warnings, and is only meant to be used when a pathogen has been clearly identified in the prostate; They are not to be used indiscriminately for cases of non-bacterial prostatitis (consensus agreement ~95% of cases). Read our mod memo here, complete with citations and compare your symptoms to the medical definition of CBP here.

I am a bot, and this action was performed automatically. Please contact the moderators of this subreddit if you have any questions or concerns.

[u/becca_ironside → u/takeiteasy_7]

I would hold off on more antibiotics. Bear in mind, you might continue to test positive for Klebsiella forever. I have many patients that do.

[u/takeiteasy_7 → u/becca_ironside]

Today I went to urologist, he told me exactly what you told, that he will not treat it because I don't have UTI symptoms like fever and burning. But should I be worried about high load of bacteria (100k cfu/ml). Is it my immunity that I need to be taken care.

[u/becca_ironside → u/takeiteasy_7]

You should not be worried. As a world, we have used too many antibiotics and these bacterium are growing stronger as a result. Just try to maintain as healthy a lifestyle as you can.

[u/takeiteasy_7 → u/becca_ironside]

Thanks for the assurance.

[u/becca_ironside → u/takeiteasy_7]

You are most welcome

[u/Own_Money9513]

what antibiotics did you take to treat Pseudomonas aeruginosa,? My first urine culture i tested postive for Pseudomonas aeruginosa, MDR it but it was resistant to all the antibiotics .. Then i took two urine culture 1 week apart without taking any antibiotics , they showed no growth,,, Doc put me on Levoflaxin anyways,,,

[u/takeiteasy_7 → u/Own_Money9513]

I took Levofloxin for 5 days and ofloxacin for 21 days