Long Term Infections?

[Stayfit823]

Doctors

About 2 weeks ago I completed a 2 week course Cipro followed by a 2 week course of doxy followed by a 2 week course of augmentin for treatment of suspected prostatitis. Symptoms were pelvic ache, testical ache, microscopic hematuria. I have had these recurrent symptoms every 12-18 months for the past 4 or so years.  Approx 4 years ago I tested positive for chlamydia, doctor prescribed doxy and symptoms were relieved, then about (1) month after that is when I experienced the pelvic testical ache. At the time my Dr did not diagnose it as prostatitis and prescribed a couple weeks of bactrim. Out of madness for relief I have gone to the internet and find conflicting reports that chlamydia or other STD can cause this condition.  I did read where Dr. Hansfied says not related but it was a post from a few years ago.  I understand that bacteria or infection in the prostate is hard to reach and cure therefore could the STD bacteria still be in there and thus causing the prostatitis? Can I pass it along if deep in prostate and thus not detected by STD tests?  Given the course of antibiotics that I just completed would a STD test for gonorrhea or chlamydia in any bodily site yield any result?

Secondly if allowed to ask a question on another topic, if not will repost.  While researching this issue I came across a thread concerning syphilis exposure. 2 years ago I had oral sex both gave and received with a male, during the 'act' I noticed a lesion on his penis, we stopped I pointed out to him to have it checked.  A week later he informed me that he had been confirmed to have syphilis. I went to my doctor and she prescribed 1g of arith and then 2 weeks of doxy, test came back non reactive.Tested again at 3 months and 6 month and non reactive. Think I read Dr Hansfield said testing at 12 mos also recommended which I did not do.  I have not had any syptoms, should I get tested again?  If it was not eradicated would antibodies show now if entering latent phase?

[Edward W Hook, MD]

"a question"?  Actually their were several and you are right, you should already know the answer.  STD bacteria do not get to the prostate since if they did, they would be considered a cuase of prostatitis.  You can believe your STD testing, with or without prostate massage.  And yes, STD treatment is reliable.

It is time for you to stop worrying aobut STD and focus on management of your prostatitis.   EWH

[Stayfit823]

Thank You Dr Hook it was helpful and appreciate the timely reply.  Just a question of clarification in your response of which my think minded head probably already knows the answer.

I understand prostatitis is not an STD and appreciate your reliable information that it does not or rarely cause the prostatitis inflammation.  However, can the STD bacteria or pathogens get inside the prostate?  If so then normal urine STD testing would still detect? and specific prostate massage sample testing etc is not needed to see if STD is in there? Normal course of antibiotic treatments for STD's would effectively treat the STD and lengthy treatments are not necessary because STD is in this very difficult little organ?

Thank You

[Edward W Hook, MD]

Welcome back to the Forum.  Prostatitis is s challenging problem for both patients and their doctors.  The symptoms you describe are certainly suggestive of prostatitis and are not typical symptoms for more common, uncomplicated STDs.  There is a widespread misconception which is even held by some doctors that prostatitis can be caused by STD pathogens. This is incorrect.  There have been a number of studies of prostatitis which indicate that common STD pathogens such as gonorrhea and chlamydia rarely, if ever, cause prostatitis.  The disease is typically due to other urinary tract bacteria which come from a person's own body, and are not acquired from others.  Treatment of prostatitis is sometimes a matter of trial and error, typically requiring prolonged therapy of a month or more and which may require more than one course of treatment.  Typically treatment is with one antibiotic rather than with sequential antibiotics but there is doctor to doctor variation in both their preferred antibiotics and the duration of therapy.  If you are comfortable with your doctor and his/her approach, I would suggest you stick with them and work to understand their approach and rationale for the decisions they make.   I would not however worry that you have and STD, see no reason for STD testing (particularly given the antibiotics you have taken) and would not worry about infecting your partner.  Prostatitis is not an STD.

Regarding question number two, you need not worry about syphilis.   Both 2 weeks of doxycycline and a single 1.0 gram dose of azithromycin have been shown to prevent syphilis in exposed persons.  Negative tests at 3 and 6 months are totally reliable and unless re-exposed to another infected partner, you do not need further follow-up syphilis testing.  

Hope these comments are helpful  Take care.  EWH