Vaginal bleeding - not bladder stones, likely not UTI.

[Lulu's Mom]

Please note: I AM working with my vet on this, not just trying to get free medical advice

My 1+yr old spayed Jack Russell mix, Lulu, was licking herself and there was blood in her urine. The 1st urinalysis supposedly revealed she had vaginitis, and the Humane Society I was fostering her for put her on an antibiotic (I never rec'd the actual results of the test).

I have since adopted her and started taking her to my own vet. A second urinalysis revealed: high WBC count, very low pH, no blood in urine. He put her on a different antibiotic (the 1st one caused gastro problems).

The bleeding stopped during meds, but resumed <2 days after the last dose. A bladder ultrasound revealed NO stones, no inflammation of the bladder wall. Vaginal cell swabs showed no indication of any stage of estrus (we were afraid that perhaps the spay done by Humane Society was 'incomplete').

The next possibility is that she has a polyp. My vet did not see a polyp in the entrance to her vagina, but did not have an endoscope to examine the full length of her vaginal vault. Before I take her to a reproductive specialist, I thought I'd see what info & suggestions I could find...
(1) An on-going case of UTI/vaginitis seems unlikely to me, since the culture failed to show any bacterial growth. BUT:
(2) If it is NOT a UTI, and is a polyp or something else instead, then why does all the bleeding stop as long as she's taking the antibiotic?

Any replies, helpful suggestions or insight any of you might have from your own knowledge or pet-owning experience would be greatly appreciated! Thanks.

[dbg10]

Antibiotics usually work for certain bacteria but not others. It is possible that the antibiotic didn't kill the bacteria that caused her vaginitis or the infection has been there so long that she will need another course of antibiotics to completely kill the bacteria involved. You said the culture failed to grow bacteria, but when was that done, during or after the antibiotics were started, or before?

Sorry I don't have any other idea, hopefully you find out what's wrong with her Sending positive thoughts your way.

[Dr Lee]

Originally Posted by Lulu's Mom

My 1+yr old spayed Jack Russell mix, Lulu, was licking herself and there was blood in her urine. The 1st urinalysis supposedly revealed she had vaginitis...
(1) An on-going case of UTI/vaginitis seems unlikely to me, since the culture failed to show any bacterial growth. BUT:
(2) If it is NOT a UTI, and is a polyp or something else instead, then why does all the bleeding stop as long as she's taking the antibiotic?

The presence of both blood and elevated WBC in the urine suggests that the inflammation is occurring in the bladder or vaginal area. (urethral issues are possible but unlikely).

To answer your questions:
1) why are the cultures negative if antibiotics help. There are several reasons why you can have false negative cultures. Some bacteria are not easy to culture such as Proteus spp. . Also there can be many reasons why the bacteria does not survive - if the pet is on an antibiotic, the handling of the sample, etc.

2) why are we responding to the antibiotics? First of all, blood in the urine is often a fluxuating thing because of the ever changing concentration of the urine and inflammation often comes and goes. Think of when you have a cold - you can feel bad but have periods of time when you think you are better but you are not. This happens with the urinary tract but usually over a longer period of time. Additionally - there could be a primary or secondary bacterial infection. (primary means that the whole problem is bacterial. Secondary means that the problem is something else but bacteria are taking advantage of the problem.) If this is the case, then antibiotics will reduce or eradicate the bacteria and reduce the level of inflammation and thus reduce the bleeding to a non visible level.

One thing that comes to mind is recurrent vaginitis. While this occurs commonly with puppies, some adult dogs can have this as well. Is her vulva red and irritated? Is there any brown discoloration there? Some dogs do have some persistent vaginitis which can be managed easily with topicals creams like neosporin for bacterial infections or fungal creams for yeast. Occasionally I have performed "face lift" surgeries near the vulva for pets that have recurrent vaginitis due to excess skin in the area which create a fold that holds urine in. (most dogs do NOT require this.) Some pets that are overweight also have problems with this however I suspect that this is not an issue here.

If vaginitis is not a problem, then endoscopy may be helpful. Also when she is having blood in the urine, a hormone test to look for ovarian tissue that may be left behind (this seems also unlikely based on the swab results).

Additionally some bacteria do take a long time to kill. It is not uncommon to try a course of 4-6 weeks on antibiotics to make sure that the bacteria is gone. For bladder infections, antibiotics should never be any less than 2 weeks minimum - anything shorter usually leaves by just enough couple bacteria to regrow and start the problem again.

I hope that this helps.

[Lulu's Mom]

I've tried to post 'Quick Replies' to both of your responses, but after typing them and submitting, both times I was sent to a page that said i couldn't post because i wasn't logged in (even though I DID log in before I clicked on the thread) Argh! Don't know if this reply will post or not - but wanted to at least try to say 'Thanks!' for your input - until I can figure out how to do more detailed quick replies to each of you
Kelly

[Lulu's Mom]

Well, Lulu finished her 2nd 2-week round of antibiotic on Tuesday, and so far... NO blood! (nothing visible, anyway)

We have a vet appt on Monday ~ a follow-up visit for both this issue as well as heartworm treatment (it'll be 6 weeks post HW-trmt on Monday) ~ but so far, I'm feeling hopeful that this was just a resistant long-term UTI.

Thanks for your input and positive thoughts!

[hazelrunpack]

Good luck at the follow-up appt, Kelly! I hope Lulu checks out perfectly!

[Lulu's Mom]

It's been a while since I was last on... thought I'd post an update.

At the follow-up appt (early March), she was still not bleeding, so we thought all was well. Urinalysis showed no blood in urine and a normal pH but a small amount of bacteria and WBC count still slightly elevated. So... back on a 3rd 2-week round of antibiotics, but it was looking like she was on the mend and we were hopeful that this final round of meds would wipe out all the bacteria so it wouldn't flare back up.

Unfortunately, on the 5th day of antibiotics, she once again started bleeding. (Previously, the bleeding stopped when antibiotics were given; and bleeding resumed after the course of antibiotics was over. Now, the bleeding BEGAN when she was already ON the antibiotics... which meant back to the drawing board - the bleeding was not due to the UTI after all. )

Long story short - she had a vaginal tumor that had grown to about 3cm diameter and was very vascular - as the tumor grew, it tore an artery and that was the source of the frank blood that leaked from her vulva.

I'm happy to report that she had a successful surgery (incl episiotomy) on Monday, stayed at the vet's overnight for observation, and came home last night... and she is doing very well!!!! She doesn't care for the Elizabethan collar, of course (although I've had a few laughs watching her learn how to navigate in it! heehee) - but hopefully it will be the last indignity she has to suffer on her way to complete HEALTH!

Abandonment & starvation, Heartworms, beginning of pneumonia due to the HW Trmt, intestinal worms, persistent UTI, and a vaginal tumor. This foster-turned-adopted dog is ready to be just a normal healthy dog!

Should have pathology results by Monday or Tuesday - lets hope the tumor is benign!

Give your four-legged family members an extra kiss and cuddle tonight, y'all ~ I hope they, and you, are well.