NGU vs. prostatitis

[Todd192]

I am a 40 year old man.  Had unprotected sex with woman and 3-4 days later began to have symptoms which progressively became worse.  Burning sensation a few seconds after urination, ejaculation, and sometime defecation.  Also soreness in penis not associated with urination, aggrevated when sitting and laying down, soreness in groin area, bladder area and seems like in testicles as well.  No discharge.  When I was 18 I had chalymidia, so I know what that feels like, and this did not match.  REgardless, I was tested for chalymidia and gonnorhea and both came out negative.  I went to my PCP and told him my symptoms, my STD concern and negative tests.  He diagnosed prostatitis and put me on ciprofloxacin for 10 days.  He also did urinalysis and nothing came up reactive.  WBC normal.  Everything normal.  So my question is, is my condition likely prostatitis or should I be concerned with an NGU that is not chlamydia?  I have a girlfriend who I am concerned about spreading something to.  Many thanks!

[H. Hunter Handsfield, M.D.]

It is conceivable you acquried NGU, and the timing certainly is consistent with that possibility.  However, the symptoms you describe are not typical for NGU or any other STD.  NGU symptoms are identical to those of chlamydia, which you have experienced.

So prostatitis indeed sounds like a good bet -- or, perhaps more likely, the chronic pelvic pain syndrome.  If you google that term, you'll find lots of information that might sound familiar; start your reading with the excellent Wikipedia article, which is one of the top google hits.  As you will see, CPPS used to be considered a form of non-infectious prostatitis, and some urologists and other providers still would call it nonbacterial prostatits.  However, you will also learn that the prostate gland might not be involved at all as the source of pain.

Ciprofloxacin may or may not have any effect.  CPPS, and many cases of true prostatitis are not due to infection at all, and antibiotics don't help.  If indeed  you actually had NGU, ciprofloxacin probably would clear it up.  Cipro hasn't been studied extensively for nonchlamydial NGU, but probably is effective.

Having said all that, there is the issue of onset of symptoms 4 days after a new sexual exposure, so I cannot say for sure you didn't pick up an infection.  Prostatitis and CPPS are not sexually acquired (except to the extent that CPPS often has an emotional component, which could be related to anxiety from the sexual indiscretion).   But if your symptoms clear up and you don't have sex with your girlfriend until you finish the cipro, she should be safe.

I hope this helps.  Best wishes--    HHH, MD

[Todd192]

thanks for getting back to me so soon.  As a follow-up, I forgot to ask if since my chlamydia test was negative, how else would you test for other NGU?  Wouldn't something have shown up on the urinalysis?  I've been urinating frequently as well and stream often does not seem to have any pressure behind it.  Are these also more symptomatic of CPPS?  Thanks again.

[H. Hunter Handsfield, M.D.]

Testing for NGU is based on physical exam (looking for signs of discharge) and urine testing for white blood cells, which would havee shown up on urinalysis.  Since those didn't show anything, you don't have NGU.

And yes, reduced force of urine stream suggests a prostate problem, which can go along with either CPPS or true prostatitis.  And at 40, you're right at the age when prostate symptoms become common.  Presumably you told your doc about that symptom.  If not, do so at your next appointment.