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Family Medicine (Expert Forum)
running out of options
Questions in the Family Medicine forum are answered by Dr. J.M. Keyes. Topics covered include general health issues, adolescence, babies, child health, eating disorders, fitness, immunizations and vaccines, infectious diseases, medical tests and procedures, and senior health.
running out of options
by JW, Nov 17, 2001 12:00AM
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
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
Doctor's Answer
by Forum-M.D.-DT, Nov 17, 2001 12:00AM
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.
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.
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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
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.