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Suggest medical tests to rule out nonbacterial prostatitis

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Posted on Wed, 4 May 2016
Question: Hi there,

I was diagnosed with Chlamydia in early XXXXXXX 2015. Upon the first sign of discharge I went to a doctor who gave me a 1000g of Azithromycin and a shot of Rocephin. Two weeks later the physician did a swab test which still showed positive for Chlamydia. A 10 day course of Doxycycline then cleared the Chlamydia. I also had a 9 panel STD test (including Trichomoniasis) done at 3 months, 5 months, and 8 months and all results came back negative.

Starting in mid-August (3 months post incident), I started having intermittent discomfort when the tip/head of my penis rubbed against my underwear. I started wearing athletic shorts, and wore them lower, and that helped a bit. Until in early November the pain become consistent and continued to increase. At its worst in December I had to keep toilet paper wrapped around the penis to prevent anything from rubbing against it. I decided to go to a urologist (UR1) who said it was abacterial prostatitis and/or peripheral neuropathy. To treat it, he gave me a two week prescription of Alfuzosin (alpha blocker to help promote blood flow to the prostate) and a one week MethylPred pack (steroid). After finishing the meds in early January the pain was still getting worse. I read up some on peripheral neuropathy, and tried massaging the tip of the penis a few times a day and also applying Capzasin a couple times. I am not sure if it was the effect of the medicine kicking in late or the home treatment, but by early February I was feeling much better. Note - UR1 also had me give a semen sample, which came back negative for bacteria, but they did not test for Chlamydia.

Afraid the pain might come back, I went to another urologist (UR2) who I had heard about from a physician. UR2 heard my symptoms, said that someone my age does not develop peripheral neuropathy. He performed a DRE and said the prostate felt 'soft and boggy' which is a sign of infection, and prescribed me 500mg Cipro two times a day for one month. I am on day 17 and have an appointment with the doctor when I am done with the medication. On my last visit, UR2 said that if the one month of Cipro does not clear the infection, then we will need to do a three month course of some of other antibiotics. And if that does not work, we will have to do IV and will need to pull-in an infectious disease specialist.

Over the last couple days I have felt the prostate area/base of penis area moderately twitch and spasm. I have no pain while urinating but in a resting state I feel pain, sensitivity and weakness in the inside of my urethra towards the base. Also in resting state my penis is about 30% more elongated than before. I also do still continue to get moderate discomfort when the tip of my penis rubs against loose underwear or clothing. A few times a week there is a shooting pain in my inguinal area, mostly on the left and occasionally on the right. And maybe once a week I feel a shooting pain down into my testicles.

What should my next steps be:
1) Prostatitis is a known complication following Chlamydia. How do I find a physician who has experience treating Prostatitis caused by Chlamydia?
2) What kind of test can I insist on to make sure we know what we are treating? Blindly throwing antibiotics at something without knowing what it is seems like a bad idea. Is it possible to test semen discharge for Chlamydia, or would that have to be done with a 3 or 4 glass study?

Here are some concerns I have:
1) It is said that infection of the prostate cannot be transmitted, but what if it is caused by Chlamydia? Isn't a portion of the ejaculation discharge from the prostate, which means it could contain the Chlamydia, right? Could I thus infect my partner?
2) The infection went from my urethra to my prostate. It could very well go to my testicles and make me infertile, right?
3) There are a few cases where the infection of the prostate spread into the blood and causes Sepsis, which has a very high morbidity rate.

Apologies for the really long message. I really appreciate any insight you might be able to share. Thank you very much.

-An otherwise healthy 28 year old
doctor
Answered by Dr. P. T. Patil (2 hours later)
Brief Answer:
Please do Culture test of urethral discharge .

Detailed Answer:
Hello
Thanks for detail history and reports of your semen and urine culture .
To summarize I would state that you have what is called as Abacterial Prostatitis .It is a very notorious disease both for patient and treating physician to treat .

The diagnosis of Abacterial Prostatitis is the last to be diagnosed and can be confirmed only on doing culture test of a urethral discharge obtained by doing a gentle prostatic massage by a qualified health personnel or Urologist .

Since you have been taking various antibiotics since six months your semen and urine culture is bound to be negative for presence of bacterial infection (Sterile).

I would suggest you to get the above mentioned test to establish and confirm the diagnosis of Non Bacterial Prostatitis.

It gives sample of secretions directly from the prostate that helps us to have precise diagnosis .

Since last 40 years I have been treating my patients of abacterial prostatitis and advise them to do prostate massage every day at home which has to be carried out by a close relative .It gives very good results .

You can discuss this regime with your treating Urologist .

As regards your doubt about transmitting infection to your female partner I would state that since you do not have any active bacterial infection as revealed by culture tests there is nothing to be worried about it .

Hope I have answered your query ,please feel free to ask if you have more questions ,I shall be happy to help you
Thanks and Regards.
Dr.Patil


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. P. T. Patil (36 hours later)
Thank you Dr. XXXXXXX for your reply. I have some follow up questions:

When UR1 sent out the semen sample to get cultured, would they have checked it or cultured it for Chlamydia too? Or is that something I need to insist on them doing?

On a related note, how is a semen culture different from an EPS culture? I was asking because I thought that the semen also has prostate fluids in it.

I wanted to share a couple interesting incidents with you - after using the bathroom I use a bidet which shoots a stream of water to clean yourself. At two separate times, once in September 2015 and once in January 2016, I noticed that the stream of water produced a good amount of semen type secretion through the penis. And if I recall correctly at both these times the water was a little warm. Do you know if what came out was purely prostate secretions, or could it have been regular semen and included sperm? Also, could this be a sign of the dysfunction of the prostate?

I have never had any prostate or other urological issues before, and have only had these issues following the XXXXXXX 2015 diagnosis of Chlamydia. That is why I believe that the issue I have is a lingering bacterial issue caused by Chlamydia or some other bacteria acquired in the process. That seems to be a plausible hypothesis, right?

Should I wait a week or 10 days after I have finished the current course of Cipro I am on right now before I go in to see the urologist, so that the antibiotics have cleared my system?

Now thinking ahead if the EPS culture does show bacteria, in your experience what kind of antibiotics are good at penetrating the prostate? And what else can I do to make sure that I am making the antibiotics as effective as they can be? For instance right now I follow the antibiotics schedule strictly and take them exactly 12 hours apart as instructed. Also the pharmacist told me to not take any dairy products an hour before or an hour after the antibiotics, which I follow strictly as well.

Thank you so very much for your help and insights, Dr XXXXXXX I sincerely appreciate it. Looking forward to hearing back from you soon.

doctor
Answered by Dr. P. T. Patil (22 minutes later)
Brief Answer:
Read detail answer below .

Detailed Answer:
Hello
Thanks for follow up .

Whenever any specimen either urine or semen is sent for culture it detects causative organisms and it is not necessary o specify any particular organism,

The watery discharge that you got from penis while bathing is thick mucus secreted by Bulbo Urethral Glands located in Bulbar part of urethra .It neither semen nor contain any sperms .It is due to natural response of these glands which are stimulated during sexual arousal during fore play and any sort of sexual stimulation by water spray in urethra.

It is always advisable to take appropriate antibiotic as per culture report .

You can continue to take Ciprofloxacin assuming that the organisms (if any) are sensitive to Ciprofloxacin .

Thanks and Regards.
Dr.Patil.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Dr. P. T. Patil

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Suggest medical tests to rule out nonbacterial prostatitis

Brief Answer: Please do Culture test of urethral discharge . Detailed Answer: Hello Thanks for detail history and reports of your semen and urine culture . To summarize I would state that you have what is called as Abacterial Prostatitis .It is a very notorious disease both for patient and treating physician to treat . The diagnosis of Abacterial Prostatitis is the last to be diagnosed and can be confirmed only on doing culture test of a urethral discharge obtained by doing a gentle prostatic massage by a qualified health personnel or Urologist . Since you have been taking various antibiotics since six months your semen and urine culture is bound to be negative for presence of bacterial infection (Sterile). I would suggest you to get the above mentioned test to establish and confirm the diagnosis of Non Bacterial Prostatitis. It gives sample of secretions directly from the prostate that helps us to have precise diagnosis . Since last 40 years I have been treating my patients of abacterial prostatitis and advise them to do prostate massage every day at home which has to be carried out by a close relative .It gives very good results . You can discuss this regime with your treating Urologist . As regards your doubt about transmitting infection to your female partner I would state that since you do not have any active bacterial infection as revealed by culture tests there is nothing to be worried about it . Hope I have answered your query ,please feel free to ask if you have more questions ,I shall be happy to help you Thanks and Regards. Dr.Patil