prostatitis or something else

[Redbeard]

hello. I am a 31 yr old male. About a year ago i began having pain above my right testicle and perineal area, dull and achy. After urination i would experience a tingling at the tip of my penis and the urge to go again right away.  On occasion my urine would come out milky white.  It looked like sperm in my urine until it dries out(occasional drops on the toilet seat).  Then, what looked like sperm has changed to look and feel like white chalk. This only happened from time to time so its been hard to catch this for a sample for my urologist who seemed clueless as to what this could be.  I was diagnosed with epididymitis and given cipro and zythromax. This has flared up numerous times and i've been given different antibiotics for each instance.  In each flare up the pain i experience can be different.  My dr. had no desire to do any test besides a urinalysis.  Due to my age he felt no reason to suspect prostate issues.  He's stuck on epididymitis as my problem.  My pain has now moved to the pelvic region.  If i were to touch the area where it hurts it would be right on my pubic bone or right behind it.  And in the inguinal node area.  It's a pulsating pain.  My testicles also ascend so much that it really hurts, very sensitive.  My scrotum becomes so tight and tender.  I no longer have any tingling or constant urge to urinate though sometimes the stream of urine seems weaker than other times.  Any second opinion or suggestions for my next dr's visit?  Also, i don't know if this matters or not.  I have IBS which causes heavy straining at times during bowel movements.  Could that do damage to anything in the pelvic floor to cause the symptoms?

[Redbeard]

Doctor,                                                                                                                                                                                                                                                                                          Thank you for your reply.  I returned to the doctors before i read your response and was given a 30 day Rx of cipro but no other test were given that you suggested at that time.  I return in Oct for a follow up visit and will try to be evaluated more as you suggested.  Thank you for your time!              

[Ash Tewari, MD, M.Ch.]

Hello Sir,

It seems as though you are for certain experiencing chronic infectious pathology. Chronic prostatitis could be the problem you are facing, also ascending infections of the urinary tract (urinary tract infections) could be complicated matters as well. A renal ultrasound would be recommended to ensure that the infection has not affected the kidneys, courses of antibiotics could be necessary as well. Also one must rule out any type of sexually transmitted diseases including chlamydia, gonorrhea and syphilis. If you have testicular pain with redness you should consult a urologist because a thorough workup including bladder ultrasounds, urine cytology, urinalysis and urine cultures along with anti-treponemal studies with STD studies should all be evaluated. Also some blood work should be performed (basic metabolic profile with complete blood count) in order to determine how severe the infection is, and if your kidneys have been damaged at all. IBS can make matters worse because of constant straining, although damage to the pelvic floor is unlikely.

Thanks!