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Taken Cipro and Z pack for prostatitis. Penile discharge on prostate exam. Penis and testicle pain. What to do?

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I have done over 40 days of Cipro and then a 5 day Z pack for prostatitis. Urologist did labs on urine before prostate exam, after prostate exam, on prostrate fluid obtained by milking, a discharge from penis when doing exam and everything came back normal. However, I had done over 30 days of Cipro before seeing him.
I started experienceing the burning pain in my penis, and left testical and at time pain in the rectum again about 7 days after stopping the zpack.

What should I do next. I contacted the urologist and he did another urinalysis but have not heard anything.
To make this more interesting I take Humaria every 10 days for Crohns and just finished a 3 month course (9mg for 30 days, 6 mg for 30 days and 3 mg for 30 days) of Encort EC.
Posted Thu, 4 Oct 2012 in Urinary and Bladder Problems
Answered by Dr. Arnab Maji 2 hours later

Thanks for your query.

Look, Z-pack usually do not work on the majority of bacteria that cause prostatitis. You had already taken 40 days of Cipro. So there is every chance of getting normal urine analysis. Again prostatitis may be abacterial also. In that case also urine analysis will be normal. I think at this situation you should have some radiological work-ups to evaluate your prostate and kidney condition like ultrasonography (USG) of kidney, urinaray bladder and prostate (KUBP). Symptoms which you are having in your left testicle and rectum may be due to prostatitis and this may also be a referred pain from kidney stone or stone elsewhere in urinary tract that may be the source of infection in your prostate also. So radiological evaluation is urgently needed here.

In other cases refractory to treatment, there is another condition that can produce similar symptoms. This disorder is ejaculatory duct obstruction. Usually the doctor will find the seminal vesicles to be very swollen on rectal examination. The patient will notice either absence or a markedly diminished semen volume. The diagnosis is made by doing a transrectal ultrasound of the prostate and seminal vesicles.

There is another entity known as pelvic myoneuropathy. This may represent up to 95% of all cases of prostatitis. This variant may be an expression of interstitial cystitis and possibly is due to autoimmune or neurogenic factors. Symptoms involves pelvic muscle spasm, nerve trigger points and some degree of anxiety (either the cause or result of the symptoms). Anti-depressant is the treatment of choice in this condition.

So USG should be done. If USG KUBP is normal, transrectal ultrasound of the prostate and seminal vesicles should be done. Besides these your urologist should do a per-rectal physical examination to assess particularly the prostate size and texture.

Therefore you should consult your urologist once more and discuss the issues which I have described and go for radiological evaluation.

Hope I have answered your queries. If you want to know further please write back to me freely. Kindly write a review on my answer.

Dr Arnab Maji

Above answer was peer-reviewed by
Follow-up: Taken Cipro and Z pack for prostatitis. Penile discharge on prostate exam. Penis and testicle pain. What to do? 8 hours later
My pcp is thinking I need cystoscopy to see what us going on. He never mentioned any ultrasound. How do you ultra the prostrate?.
I have had cts in past four crohns and seminal vessels were always enlarged.
Answered by Dr. Arnab Maji 4 hours later

Thanks for writing back.

Cystoscopy can be done but trans-rectal ultrasonography is more accurate in the evaluation of prostate. Though ultrasonography of KUBP can detect enlarged prostate but more accurate evaluation of prostate and seminal vesicle can be done by introducing USG probe in your rectum that is trans-rectal USG. By cystoscopy prostatic urethra is visualised and an idea can be made on prostate size and bladder rather than prostate can be directly visualised. But as far as prostatic disease is concerned trans-rectal USG (TRUS) is the most sensitive investigation.

Urologists have recently incorporated TRUS as asensitive tool in the evaluation of prostatic diseases especially to evaluate the extent of disease and to take guided biopsy and at the same time informations can be obtained regarding rectum, seminal vesicles and adjacent lymph nodes.

Hope I have answered you. If you have more queries please write back to me. Discuss this issue with your PCP.

Dr Arnab Maji
Above answer was peer-reviewed by
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