running out of options

Here are the facts:

2 months ago I went to the ER for frequent urination, and groin pain (No discharge or pain).  I was given a prostate exam which hurt like hell but he said it was normal. I was "diagnosed" with epididymytis and given Doxycliclne for 10 days.  This seemed to work, however, upon coming off I got the symptoms back.

I went to a urologist who gave me another prostate exam and said it was enlarged.  he prescribed 20 days of Cypro which worked very well.

2 days after the cypro ended my glands on the right side enlarged(Parotid and submandibular and remained enlarged intermittently for a week or so.  It seemed like it was unilateral for the most part.  

I was since given a strep test,CBC (normal), mono spot test, went to a dentist, and a dental specialist.  Not to mention a EET who said my ears and throat were fine.

Other symptoms:
1. very slight fever(not all the time)99-100 degrees
2. jaw pain(back of jaw)
3. unilateral gland pain(mainly Parotid)on the right side
4.  Ear discomfort on that same side
5.  slight fatigue
6. occassional headache in right eye and face pressure
7.  occassional dry mouth

after two weeks of this I am losing my mind and thinking the worst.  I have never had any STD's.  My last sexual encounter was 11 weeks ago(protected)with a woman with unprotected oral sex. The only unprotected sex I have had was oral sex in the last 3 years.


your advice or direction is appreciated

[Forum-M.D.-DT]

OK,
For starters, if you have had "protected" sex, epididymitis is not likely. However, you mention the prostate exam "hurt like hell" I understand prostate exams are uncomfortable, however, if there is inflammation of the prostate gland, this is going to hurt when they do a prostate exam. You really can't "feel" prostatitis and, for the most part, the diagnosis is made on the "symptoms" a patient presents with. Certainly, prostatitis can be associated with some pain on examination of the prostate and possibly blood in the urine or semen. The fact that you got better with Cipro, makes me think you did, at one point, have prostatitis.
Now, the second set of symptoms you describe seem to be related to some inflammation or infection of the parotid gland or possibly the submandibular gland. These are glands which are near the ear and jaw respectively and may have become inflamed. Commonly, stones can occude the ducts which "empty" these glands and this can cause, in addition to pain, fever, jaw pain, ear discomfort, headache and "pressure" as you describe.
Also, secondary fungal infections will commonly occur when patients are on antibiotics for many weeks. I have had more than one patient come to my office with mouth/throat pain after being on antibiotics. While a CBC, mono and strep test may be normal, a fungal infection may indeed be present. This may have been overlooked in your case.
My plan for you would be
#1 make sure there is no evidence of some "obstruction" of the parotid or submandibular gland
#2 Check your mouth closely for any redness or exudate which may indicate a fungal infection.
#3 I would be inclined to "try" and antifungal medication (i.e. Diflucan) if all "appeared" normal to see if this may be helpful.

If you want to ask another question or have further clarification about this question ... post it as a comment and I will respond. I would like to work with you to get this problem solved.
Dean M. Tomasello, M.D.

[JW]

Thanks for your quick response.  I forgot to mention that the original symptoms of prostitis came back to a lesser extent so I was put back on cipro.  I understand that treatment of prostitis is very difficult in most cases?  Is prostitis normal for someone 31 years old?

To answer your questions:
1.  My throat was red/pink which led to the strep/mono test.
2.  I find a thick mucus type consistency in my throat and the top/back of my mouth most of the day.
3.  I also get a white/green coating on the back half of my tongue most often when I get up in the morning.(could antibiotics cause this?)

I was recently(2 days ago) put on Augmentin to see if the Parotid discomfort is actually a secondary infection from the cypro treatment. I was told that cypro didn't treat head infections too well.  At which point am I taking too many damn medications?

I must say that this forum has given me more direction than 2 months of "revolving door doctor visits".  My mind is starting to take over and think the worst...HIV and Cancer.  While I realize this is unlikely being that I can't even remember the last time my glands were swollen, I am still thinking the worst.

Once again, your help and direction are appreciated

[Tomasello_MD]

Your further comments support my initial thoughts. Why? Well, for starters, you now tell me that you have been on repeated doses of antibiotics and describe a "mouth infection" which is quite likely a fungal infection. Also, I have to disagree with one thing that you (or your doctor) said, that being that Cipro "doesn't treat head infections too well"
For example, the most common causes of bacterial infection of the ear, nose, throat are Streptococcus, Hemophilus, and Moroxella. All of which will be killed by Cipro.
Seriously, look into having this treated as a fungal infection, with all the antibiotics you have been on as well as the symptoms you currently describe ... this is very likely cause.

[athy]

I have facial pain on left side for 8yrs. I'm running out of specialist. I've had exploratory surgery with one doctor and my parotid gland removed by another.I keep thinking the pain has something to do with my gland, the pain seems to be greater on the upper side.There were 3 small masses found. 1 on the parotid gland another on the muscle and on upper gland.When I tell doctor's I get relief from the pain "When I chew" it confuses them.I am so frustrated with not being able to find what is wrong and the pain is horrible.

[athy]

I have facial pain on left side for 8yrs. I'm running out of specialist. I've had exploratory surgery with one doctor and my parotid gland removed by another.I keep thinking the pain has something to do with my gland, the pain seems to be greater on the upper side.There were 3 small masses found. 1 on the parotid gland another on the muscle and on upper gland.When I tell doctor's I get relief from the pain "When I chew" it confuses them.I am so frustrated with not being able to find what is wrong and the pain is horrible.