Prostatitis -- don't know what to do -- please help

Dear Dr. H,
First of all, thank you very much for your help.
I am a 21 yrs old male. The story began in Oct 2004, I had sex with a sex worker. First, I performed oral sex to her witout protection, then I had protected virginal sex with her. Because I did not eject, she changed a new condom and performed oral sex to me (protected). However, I still couldn't eject, then I had virginal sex with her again. Still I couldn't eject, she changed another condom, then oral sex, then virginal sex...totally condoms were changed 3 times.
Finally when I had my mind again, I was deadly afraid that I might got STD, because during the change of condom, her viginal fluid might get into my body through the tip of my penis.
3 weeks later, I consulted a health provider. I was tested for Chlamydia and gono (both sample taken form uretha), HIV, VDRL, TPHA, HSV2, all came back negative.
However, there were pain in my uretha, 6 weeks after the exposure I was tested again for trich and Chlam (both from VB1 sample), VDRL, TPHA and HSV2. All back negative except the trich, then I was treated with 2 weeks antibiotic (I don't know what the drug is but may be Flagyl).After 11 days there's still pain in my uretha and scrotum. 8 week after exposure I was tested again for Chlam, Gono (both semen sample) and trich (VB1 sample, antigen test) The Trich test came back negative but the Chlam test showed weak reaction. Then the doc gave me a new antibiotic for 2 weeks.
But my bad luck did not stop there. one week later, there was pain in my left testicle. I went to emergency room then the doc gave

[H. Hunter Handsfield, M.D.]

There's obviously more information coming in a comment I haven't seen yet.  But your risk of STD from that exposure was low, and based on the test results you don't have any infection.  I doubt you have prostatitis either, even though many doctors make that as a "wastebasket" diagnosis; most "prostatitis" in men your age isn't a prostate gland infection at all.  (A wastebasket diagnosis is when a clinician can't come up with a clear answer and makes an assumption about the diagnosis.)  Your urethral pain more likely is psychogenic, i.e. anxiety magnifying normal body sensations.  But I wait to see more about your testicular pain.

HHH, MD

[unknownSpace]

Sorry, my story is too long, has to post it seperately.
To continue, there was pain in my left testicle, no swollen. I went to emergency room then the doc gave me two weeks of minocycle. It did not resolve my problem. Niddle like pain were in urethra, scrotum, and near anus.
On Feb 2005, I was diagnosed with Prostatitis (Staphylococcus was found) and hospitalized for 5 days (no fever). After checked out from hospital for 10 days, EPS culture was performed and no germ was found this time. But the niddle like pain was still there in urethra and scrotum. Although the doc told me the pain came from my anxiety, but I didn't think so.
Anyway, I went to another urologist, I was performed a prostate ultrasound and Cystocpoy, both came back noraml. However, E. Coli was found in semen culture as well as in middle stream urine culture. Now I have taken Levofloxacin (400mg once per day) for 5 weeks already, and the syndrome still there, niddle like pain in urethra, penis, public hair area and scrotum, tingling feeling in the skin of public hair area, penis and scrotum.
Doctor, could you please answer me the following questions:
1. In a full STD screen, what kind of test should it include? Did my doctor give me a full STD screen? Did my doctor do those tests in the right time (after incubation period)? (Sorry to say, I am living in asia area, and there's no STD specialist I can find, only urologist and dermatologist)
2. Regarding the Chlamydia and Gono test, which kind of sample will give the most accurate result? sample from urethra swab, urine, or semen?
3. I couldn't stop thinking that my chronic prosatitis is coursed by Trich or Fungi besides bacteria, since I did have sex with a sex worker, but several urologists said that the chance is very low that they denied performing trich / fungi test for me. Dr. H, what's your opinion?
4. If I insist on getting a trich and fungi test, what kind of test will give me the most accurate result? Where should the sample be taken? using EPS or semen?
5. 5 weeks of levofloxacin still couldn't get rid of the symdrome, I am afraid that besides E. coli there's still another kind of germs. My semen culture test says there's heavy growth of E. coli, can it happen that E. coli is growing too heavy so that other germs couldn't be seen by the operator?
6. How long should I take antibiotics? till all symdrome disappear?
7. One of the urologists I consulted use the semen culture instead of EPS culture to diagnose my prostatitis, is it correct?
8. After I stop my antibiotic, how long should I wait before another culture test is performed? and should I get an EPS culture or semen culture? Which one is better?
9. If I don't recover after a long period, should I get my prostate removed? does it affect my fertility?
10. Is prostatits an infectious disease? is it related to my sex worker exposure?
11. Besides taking antibiotics, what else should I do? Which else tests should I be performed? Doctor H, I am very stressful at this moment, please give me some help.

  Thank you for you help and the creator of this forum, this benefits people a lot, espically for those who couldn't consult a STD specialist in their living area.

[unknownSpace]

hello?

[H. Hunter Handsfield, M.D.]

Even with the additional information, I remain unconvinced that you actually had prostatitis.  Certain strains of staph and E. coli can be common contaminants in the genital tract, not indicating infection.  And from the start I thought your symptoms were more typical of anxiety than infection; in that aspect, your doctor and I agree with one another.  Otherwise, I am going to respond only to your questions that address STD issues; for the others, you'll need to continue to follow the advice of your own doctors.

1) You had a very complete STD evaluation, especially in view of the low risk nature of the exposure you describe.

2) The sample for chlamydia and gonorrhea testing (urethral swab, urine, etc) is less important than the test method.  Since you had a urine specimen ("VB1"), the test almost certainly was a nucleic acid amplification test, which is the best kind available.  You can be 99% certain you never had gonorrhea or chlamydia; and 100% certain that if you did, it was cured by the treatments you received.

3) The urologists are right.

4) No need to test for trich.

5-11) I don't think your current symptoms indicate an infection or any other serious problem, except for the anxiety you obviously are experiencing.  I do not think additional antibiotics will help.  As I said initially, "prostatitis" often is not a distinct entity (the American Urological Association classifies men with your symptoms as "pelvic pain syndrome" rather than prostatitis).  My suspicion is your next best bet is a visit to a mental health professional (which I suggest out of compassion, not criticism).  But I can't second-guess your own doctors; you should follow their advice.  (And good God, no, you don't need your prostate removed!)

Good luck-- HHH, MD

[Vegeta]

Dear Dr. H

i'm sry to post this here but everytime i try to post its always full.
9 days ago I had unprotected vaginal and oral sex with a girl who has had many partners. it only lasted for a bout one minute until i came to my senses and realized i should stop. As soon as this happened i rushed to the bathroom and washed my penis hoping i dont catch anythings. Since than ive been having all types of symptoms, for a day or two there was a burning/stinging sensations on the tip of my penis, than i started to have a drip of urine after i urinated, theres a pain in my testicles, i began to have stomach cramps and lower back pain, i started feeling a sharp pain in my toe, and on my left knee, ive been really fatigued and havnt had an appetite. and i have also lost some weight due to this. Also when i examined my penis about 5 days ago there was a small black mark that appeared out of no where and disappeared in 2 or 3 days. now a bump has appeared on the shaft of my penis and i'm basically freakin out. i went to see the doctor yesterday for an std check and he told me to call him 2 days from now for the results. I dont think i have chylamidia or gnorrea being that it doesnt burn when i pee. and yesterday night a small rash appeared on my left shoulder and ive been worring weather or not its herpes. Basically ever since that day ive been worring myself to death constantly thinking about it and going online reading up on std symptoms. As i waited for my Dr. appointment i was really anxious and nervous of what could be. my Dr. tells me that these symptoms could be herpe symptoms and told me that i should wait about 6 months to come back and have a herpes and HIV test done. and till than i should look for symptoms like rashes around my genital areas. but this has me all worked up Dr. could this all be mental and due from stress or are these symptoms of HIV or Herpes. Please help me out doc

[Vegeta]

also ive had an urge to urinate often and the when i finish and have the drip of urine its not a discharge like with chylamidia. its just urine that i have to excessivly shake to get rid of which i never had until now. my doc tells me not to worry about the bump being that i already have a couple of small bumps around my penis area thats always been there. but this bump looks different and has come at the wrong time. its looks as if it might start growing and it glistens like something could be in there.

[Vegeta]

one last thing, ive also been having to clear my throat often and it feels like my saliva is sticky and when i swallow it, it stays in my throat, i fear the worse is happening to me

[T-Cat]

I have a few comments, firstly for unknownSpace, secondly for Vegeta.

unknownSpace - dont worry man, I went through much, though not all of what you went through.  I know that there were conflicting reports along the way, but both you and I know you definately had something wrong - however, it has since been cured. Anything that is lingering behind now is all in your head, I know this because the same thing happened to me. I know somethimes its almost hard to believe it when you are cured of an ailment thats been bugging you for ages, a persistant pain for example. The human brain works in mad (excuse the term) ways and even after the problem is gone, the pain can still appear to be there.  This is ESPECIALLY so the case with problems in that region (groin, lower stomache, lower back, testicals, penis etc) of the body.  We all also know there are a vast and especially concentrated network of nerves in some of those areas especially, directly connected to your brain via your spinal chord.  Anyway, go figure - what im trying to say is this - I also had lingering pain after i was cured of epididymitis (caused by an undetected and not correctly eradiacated chlamydia infection). Its a simple case of positive thinking and getting along with the other things in your life; and dont forget - just because you have a pain of some kind in some part of that "region" doesnt mean youve still got a problem, its just means your body is firing off nerves.  If you werent looking for it, you would never notice it.  Youre cured man, breath the fresh air of health!

Vegeta:
If you are actually truely being serious, then you dont need to worry.  All of the "symptoms" of the diseases you are worried about take longer than 9 days to manifest themselves, and certianly wouldnt appear any sooner.  Drink some water, smoke a bone and bag up (wear protection) every time.

[unknownSpace]

Dear Dr. H,
  I just don't know why your answer and other people's comment are not displayed. Is there anything wrong with the forum?

[unknownSpace]

testing

[unknownSpace]

The answer and comment can not be displayed....strange

[Vegeta]

thanx T-Cat but ive been really worried and it says that herpes symtoms (symptoms) can take place in 10 to 20 days, i'll feel better once i hear from the doc

[H. Hunter Handsfield, M.D.]

Your symptoms don't sound like HIV or herpes.  As I have said many

[T-Cat]

Vegeta, relax man - you are going to test negative for EVERYTHING i tell you right now.

[Vegeta]

thx guys, i'll try to relax until then