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Have epididymitis. Getting discomfort in pelvic and thigh after ejaculation. Taking doxycycline, naproxen

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I was diagnosed with epididymitis 3months back, I took the medications but it still lingered. Recently the pain went away but sometime I get discomfort in my pelvic, thigh area, only in the right side. After ejaculation I see the pain increasing. Till now my medication were doxycycline, bactrim, meloxicam and naproxen. Do you think it is a cause of infection or inflammed epididymitis. Also for inflamed epididymitis what treatment should I look out for.
Posted Fri, 19 Apr 2013 in Urinary and Bladder Problems
 
 
Answered by Dr. V. Sasanka 4 hours later
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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Follow-up: Have epididymitis. Getting discomfort in pelvic and thigh after ejaculation. Taking doxycycline, naproxen 16 hours later
Hello

I went to my urologist and he told me to take cipro 5mg twice a day for 1 month. Based on my previous and current medication, do you think that my epididymitis is related to sti or enteric organism. Also I took urinalysis which reported as negative, do you think I should consider taking urine or sperm culture or urinalysis is enough to rule out bacteria.
 
 
Answered by Dr. V. Sasanka 7 hours later
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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Follow-up: Have epididymitis. Getting discomfort in pelvic and thigh after ejaculation. Taking doxycycline, naproxen 18 hours later
After 2 tablets of cipro itself, i started having numbness and tingling. So is there any other alternative for cipro and do you think my side affects are serious that I should stop them right away?
 
 
Answered by Dr. V. Sasanka 6 hours later
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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Follow-up: Have epididymitis. Getting discomfort in pelvic and thigh after ejaculation. Taking doxycycline, naproxen 2 days later
I'm starting to have pain in my abdomen, so if it were prostatis too, should I just use the same treatment. Also what do is the best medication for epididymitis between Trimethoprim-Sulfamethoxazole combination, Cephalosporins or quinolones.

Thanks
 
 
Answered by Dr. V. Sasanka 7 hours later
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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Follow-up: Have epididymitis. Getting discomfort in pelvic and thigh after ejaculation. Taking doxycycline, naproxen 44 hours later
Hi,
My urologist now gave me Clindamycin for 30 days. I don't see it having as much improvement as the cipro had only after 1 day for my condition. So do you think clindamycin as a better alternative to cipro or not.

Thanks
 
 
Answered by Dr. V. Sasanka 4 hours later
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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Follow-up: Have epididymitis. Getting discomfort in pelvic and thigh after ejaculation. Taking doxycycline, naproxen 2 days later
Hi I tried clindamycin but it wasn't as effective as cipro so I took cipro again yesterday and felt better but have been having muscle tightness and body pains like symptoms. Do you think my side effects of cipro are normal or are severe side effects that I should stop now now. Because of black box warning and tendonitis stories, I'm scared to continue but am in a dilema because cipro is helping me with my epididymitis pain.
 
 
Answered by Dr. V. Sasanka 2 hours later
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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Follow-up: Have epididymitis. Getting discomfort in pelvic and thigh after ejaculation. Taking doxycycline, naproxen 10 hours later
Hello,
I now have tendon pains in heels, so I have now stopped it and am taking Magnesium to detox it. Is it a good idea to take magnesium. Also what I observed was after taking cipro I felt better regarding epididymitis. So is there a better alternative to cipro other than clindamycin. Also based on my medication doxycycline, Bactrim-DS,Cipro, Clindamycin does it look like sti related or not as I experienced pain in my right testicle but no swelling, exactly two days after an exposure(sexual intercourse).

Thanks.
 
 
Answered by Dr. V. Sasanka 5 hours later
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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Follow-up: Have epididymitis. Getting discomfort in pelvic and thigh after ejaculation. Taking doxycycline, naproxen 2 days later
Hello,
So right now I feel like for my epididymitis, I have to try all the antibiotics and then know if it had cured or not. Since I am allergic to cipro(quinolenes), are there any other drugs I have to be careful of from now on. And also after starting an antibiotic course rather than completing the 30 day course, how many days and what signs should I wait for to know if the antibiotic is working or not.

Thanks
 
 
Answered by Dr. V. Sasanka 6 hours later
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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Follow-up: Have epididymitis. Getting discomfort in pelvic and thigh after ejaculation. Taking doxycycline, naproxen 2 days later
Hello,
I first got diagnosed with epididymitis 4 months back. I got the pain in my testicle 2 days after my first sexual exposure. Is it common for epididymitis show up as early as 2 days or not. Prior to that I had no exposure. Also I remember having flu like symptoms, sore throat feverish when I got epididymitis. HIV test, gonorrhea and chlamydia are all negative. So could this be viral epididymitis or not and is there a treatment for this kind.

Thanks
 
 
Answered by Dr. V. Sasanka 29 hours later
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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