Hi,
The epididymis is a structure that connects the testes to the vas which is a tubular structure and provides path for sperm to travel after their production. This also stores sperm till the next time they are let out.
Infections of epididymis are relatively uncommon compared to infection of urinary bladder or urethra, but once an infection establishes itself, it takes a long while for it to disappear. also, infection may not be localized to only epididymis, and also may involve other organs of male reproductive tract nearby such as prostate. Ideally, antibiotics should be given for a longer duration than usual, on occasions up to 3 months or more. Till the infection totally disappears, the patient could have all the symptoms that you have been having - pain (or more commonly ache or discomfort) locally, pain in the perineum, and lower abdomen, and again relation to intercourse or ejaculation is common.
You will be happy to know that you have received almost all the correct medication which is given for this condition. Sometimes if evidence of infection still exists, as for example a urinalysis showing plenty of pus cells, you might have to be continued on antibiotics like Ciprofloxacin,which might be better than doxycycline. Alpha-blockers are drugs to relieve spasm at level of bladder neck, and might help.
You can also try 'sitz baths' - where you immerse your bottom in a bathtub of tepid water and sit relaxedly for 30 minutes or so everyday. anti-inflammatory drugs like Naproxen may give pain relief, but do take only when absolutely necessary, as they have their own side-effects.
Baclofen is a drug to produce skeletal muscle relaxation and might prove to be of benefit in your case.
Relaxation exercises like Tai-chi or Yoga also have been shown to give benefit.
Hope I have answered all your questions.
Regards.

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Hi,
Ciprofloxacin 500mg twice a day sounds like a good choice.
Urine analysis is reasonably good to indicate infection. If there are no or only few pus cells on urine examination, it is unlikely that a urine culture will grow any organisms.
I think in your case, as in most cases of epididymal infections, the infection is from enteric organisms from the urinary tract.
Sperm culture is notoriously inaccurate in predicting presence of infection. It usually grows bacteria from the urethra which is the common passage for the exit of both sperm and urine, and is therefore usually not reliable at all.
If your symptoms are coming down, I suggest you follow the antibiotics as advised by your urologist. Avoid stress, do take care of general health, including hydration and rest, and you will start feeling much better.

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Hi,
Numbness and tingling are usually not likely to be severe enough to warrant discontinuation of Ciprofloxacin, but obviously patient's comfort is paramount, and thus if you think these side-effects are serious enough for you to try other medications, you can change to any other good antibiotic which can be administered on a long term basis.
Choices would be Trimethoprim-Sulfamethoxazole combination or Cephalosporins or other quinolones like ofloxacin or levofloxacin (which however might have a side effect profile similar to Ciprofloxacin). The prescription can come from the treating physician or urologist after thorough discussion.

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Hi,
Quinolones work well for prostatitis. In fact, Many reports have quoted that relief obtained by the patient after 2 months of treatment with quinolones is apparently equal to 3 months of treatment with Trimethoprim-Sulfamethoxazole. They work equally well for epididymal infections.
If you have pain in abdomen, it could also be due to non-specific gastritis, and you can try using drugs like Ranintidine or Pantoprazole before changing medicines.
Hope you get better, and let me know your progress.

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Hi,
When it is a question of a a choice of antibiotics, many urologists prefer to rely on individual experience in treatment of a similar illness in the past, or hospital antibiotic usage guidelines rather than go by the textbook. This is a practical approach and need not be taken negatively.
Clindamycin by itself is not bad drug for your kind of infection, and might even have been the first choice at the onset of the symptoms, but I really am not comfortable in prescribing it in a patient 3 months after diagnosis, especially considering that you might be requiring to take a drug on a long term basis, as it does have a significant side-effect profile.

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Hi,
Obviously tendinitis is a concern, but it is more theoretical, and in all my clinical practice, I still have not seen an adult suffering from this. Maybe I am lucky, but I certainly do feel that in your case if you are deriving benefit from use of ciprofloxacin, please do continue using it unless you develop a side effect yourself, which is a remote possibility.
Many people do have a non-specific inflammation of pelvic organs following the kind of infection that you have developed, and the result is usually the tightness that is present in lower abdomen along with a sense of malaise and fatigue. Aciteminophen may help and is safe in moderate dosage, but some people may also have to use drugs called alpha-blockers to release the tension at bladder neck, and baclofen is a drug for reducing skeletal muscle tension. These are prescription drugs meaning you will require a doctor to write out the dosage, and so you can ask your urologist for his opinion.
Physical measures like 'sitz baths' - where you immerse your bottom in a tub of tepid water and sit relaxedly for half an hour - may help. Yoga or taichi could also be useful. Ensure good bowel movements everyday- this will avoid local pelvic trigger factors.
Hope you will do well. Let me know what is happening.

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Hi again,
If you do indeed have tendon pain, I suppose Ciprofloxacin should definitely be avoided. Magnesium might be more helpful in the recovery of magnesium deficiency related tendinitis, but I guess there is no harm in it's use even in this scenario.
I obviously cannot rule out an sti, but you could have acquired this infection in many other ways too. So you might need a few more tests like USG for prostate and seminal vesicles through a transrectal route, a uroflowmetry to see if you are voiding well, also an estimate of how much of urine is left behind after you finish voiding urine, and a complete urinalysis and a urine culture if there are significant pus cells in urine. Based on these, the urologist will have a better idea if you need antibiotics alone or to add drugs like alpha-blockers.

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Hi,
The problem with tendon pain that you had is not an allergic reaction and thus there is no specific need for you to worry about the use of every other antibiotic. In the future, should the need arise, obviously it would be important to let any treating physician know that you do not tolerate this class of drugs ('quinolones') so that they will suggest an alternative.
Even if a drug is working, it would be prudent for you to complete 8 weeks of regular treatment. There are several ways for you to know if a drug is working or not - One of them is by doing urine examination on a regular basis and looking for pus cells, another would be for yourself to judge if your symptoms are improving. This condition usually resolves slowly, and thus do not anticipate sensational outcomes from day one of changing an antibiotic.

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Hi,
It is possible for you to have developed your epididymitis as a result of sexual exposure, considering that there seems to be a significant cause-and-effect relationship here.
Chlamydia do not show up very well on lab tests, and therefore a negative result for chlamydia needs to be taken with appropriate clinical correlation.
If you are feeling comfortable with the current medication, I suggest you quit worrying about the cause - viral or bacterial or chlamydial- and instead finish the course, and then evaluate for the response.

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